[Congressional Record Volume 140, Number 114 (Monday, August 15, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 15, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                          HEALTH SECURITY ACT

  The PRESIDENT pro tempore. The Senate will now resume consideration 
of the bill, S. 2351, which the clerk will report.
  The legislative clerk read as follows:

       A bill (S. 2351) to achieve universal health insurance 
     coverage, and for other purposes.

  The Senate resumed consideration of the bill.

       Pending:
       Mitchell amendment No. 2560, in the nature of a substitute.
       Dodd amendment No. 2561 (to amendment No. 2560), to promote 
     early and effective health care services for pregnant women 
     and children.

  Mr. WALLOP addressed the Chair.
  The PRESIDENT pro tempore. The Senator from Wyoming.
  Mr. WALLOP. Mr. President, I inform the Chair that I have been asked 
by Senator Packwood to stand in for him while he goes to the same 
meeting.
  With that, I yield such time to the Senator from Oklahoma as he 
chooses to take.
  The PRESIDENT pro tempore. The Senator from Oklahoma [Mr. Nickles] is 
recognized for such time as he may consume.
  Mr. NICKLES. Mr. President, I thank my friend and colleague from 
Wyoming. I just express my sadness that this is his last year in the 
Senate, because he has been an outstanding Member of the Senate on a 
lot of issues, including this issue. I appreciate his work and 
contribution not only on behalf of the State of Wyoming but also for 
our country, as well.
  Mr. President, many have taken to the floor and many of us have had a 
great deal of discussion on the issue of health care. It is not a new 
issue, just because we now have a 1,443-page bill. It is a complicated 
issue. But we have been working on it for a long time. A lot of us have 
been working on this issue for a long time.
  Last year, I introduced the consumer choice health care bill. We had 
25 cosponsors, one-fourth of the Senate as cosponsors on that 
legislation to try to remedy some of the problems that the majority 
leader just discussed.
  The majority leader mentioned problems where some people might have 
insurance and might lose it because they become ill. We addressed that 
in our bill. We addressed it in the Dole bill. I hope that we will pass 
legislation to solve that problem this year.
  We addressed problems where some people might not be able to buy 
insurance because they have a preexisting illness. And I think a lot of 
us have found that is the case in our families.
  A few years ago, I found out that I had a little cancer; no big deal. 
But I remember, I asked the doctor what that meant. He said, ``Well, 
you won't be able to buy insurance.''
  Well, he was wrong, because I am under the Federal employee system. 
And Federal employees' preexisting illnesses are covered, so I was 
covered.
  They do that for 10 million employees and their families, why can we 
not do that for everybody in America? So we took care of that in the 
bill I introduced. It is taken care of, frankly, in the bill Senator 
Dole offered and I believe in Senator Mitchell's bill, and we ought to 
pass that this year. We ought to pass some things that would help solve 
some of the problems.
  I know when President Clinton and Mrs. Clinton are on the road all 
the time they are talking about somebody who has a terrible health care 
problem and has a preexisting illness, they cannot get insurance or 
they lose their insurance because they really become ill, and they had 
a catastrophe, and the insurance rates go sky high. We ought to solve 
those problems and we can, and we can solve those in a bipartisan 
fashion.
  I might mention, I think it was a couple years ago, now, we passed 
legislation that Senator Bentsen and others were working on that 
incorporated solutions to those problems. Those are positive, 
significant solutions. We hear people going to the floor and saying, 
``We have 37 million people who are uninsured, let us help those 
people.'' We should, and there are differences of opinion on how we 
should do that. Some would propose it through a mandate--that was in 
President Clinton's proposal. It is in Congressman Gephardt's proposal. 
Senator Mitchell has a kind of delayed mandate. He says if you do not 
get to 95 percent, then the mandate would hit or would be triggered.
  I might mention it would be triggered in a State like mine and 
probably West Virginia and a lot of States. You would have a big 
mandate, mandating on every business and every individual that they 
have to provide a Government-defined package.
  I disagree with that solution. I do not disagree with the idea of 
trying to help those people who need help. I do not disagree with the 
idea, or the goal of trying to have everybody have some type of health 
care--which, frankly, they do have today. Not everybody has prepaid 
health insurance. Not everybody has a prepaid health care system. But 
everybody has some degree of health care.
  Mr. WALLOP. Will the Senator yield for question on the mandate issue 
he just raised?
  Mr. NICKLES. I will be happy to.
  Mr. WALLOP. Is it not true that under the Mitchell-Clinton mandate 
provision, once it triggers, it triggers State by State setting up real 
distortions in job markets between States that are mandated and States 
that are not? Would that not be the case?
  Mr. NICKLES. The Senator is correct. I will mention that in a moment. 
But the Senator is right. It is a State-by-State mandate, so if you 
have one State at 95 percent the mandate would not be triggered. If you 
have a State that is 90 percent, it would be triggered. And you can 
easily see a scenario where business becomes flexible and jumps from 
one State to another, in several States, where you would have 
businesses fleeing the mandate because, frankly, a lot of businesses 
cannot afford the mandate. It is very expensive. I will get into the 
cost of this in just a moment.
  The problem I am trying to address is: Let us identify the problem 
and then let us try to solve it. If 37 million people do not have 
insurance, how long do they not have it for? Are these chronically 
uninsured people? Because we hear this term and it sounds pretty large 
in a population of almost 260 million people in the country.
  I did a little homework on it. Actually I did not, the Urban 
Institute did the homework. It said the figure of 37 million uninsured 
is a snapshot, at one point. Their study found that most of the people 
who lose their insurance get it back within a very short period of 
time. The study found half of the uninsured go without coverage for 
less than 5 months. That is interesting: 70 percent get coverage back 
within 9 months. Only 19 percent are uncovered for 2 years or more.
  So, 19 percent of 37 million people, that is probably about 7.5 
million people who are what I would categorize as chronically uninsured 
or very hard to insure for whatever reason. I have already said let us 
solve some of those problems; let us make sure that if somebody has a 
preexisting illness, they can buy insurance. Let us make sure somebody 
is not dumped out of the insurance market because they have become ill. 
This will solve some of the problems.
  Let us solve some of the portability problems so if somebody changes 
jobs or loses jobs, for whatever reason, they can continue to be 
insured. That is in the legislation I have cosponsored in Senator 
Dole's package, and I imagine in most of the bills. We can pass that. 
We can pass that today or this year. So we can make some positive, 
constructive steps toward alleviating the problem for the people who 
are uninsured.
  I might mention, too, for the people who are uninsured, the 37 
million, 70 percent will have insurance within 9 months. What is the 
biggest category of people who are uninsured? Young adults, age 18 to 
24, who are the most vulnerable to lapses in coverage. I could go on. 
Most of them had coverage within a month or couple of months of losing 
the coverage. They might be in a situation like I was. I had a daughter 
who turned 22. She graduated from college; she was going to go to 
graduate school. So there might have been a lapse had we not moved 
pretty quickly to get her enrolled. She was no longer covered under my 
family plan so we had to enroll her on her own coverage. We did that. 
But it would be easy to see how that coverage could lapse for a month 
or two.

  But that is not really the problem. That is not the reason why we 
need a Federal solution. And that is not the reason why we need 
legislation today. What about some of the others? Not everyone who 
lacks insurance is poor. According to the Employee Benefit Research 
Institute, nearly half the uninsured have incomes of more than $20,000, 
and 17 percent have incomes of more than $40,000. So I think we can 
exclude those individuals who, for whatever reason, have decided they 
did not want insurance or they are going to wing it, they are going to 
gamble that they will be healthy forever. I do not think that is the 
need for a Federal program. I do not see that as the solution.
  Let us solve some of these problems that would help it, but I hope, 
let us make a rule in the Senate, or try to make sure, that we do no 
harm. We have quality health care in this country. I know every person 
in this body--but I would also say in America today--has been a 
beneficiary to some extent of the best quality health care system in 
the world; or certainly their families have, for whatever reason. Let 
us try to make sure we do no harm to this quality health care system.
  Some people say, ``Wait a minute, we compare the United States to 
other industrialized countries and we spend more per capita, we spend 
more per person, we spend more in total amount of dollars--the amount 
of money we spend in health care today in the United States alone is 
bigger than the economies in many other countries.'' That is probably 
true. But we have an asset, we have a real quality health care system 
in this country. Let us not emulate countries that do not have quality 
health care. Let us not emulate countries that cannot give care. Let us 
not emulate countries that have care, it is cheap--I would guess they 
would say in the former Soviet Union they had health care for 
everybody. But I would also venture to say most people would say it is 
not very good; or in East Germany or some places. Some people say, 
``Let us emulate Germany or Canada or Great Britain.'' Again, they have 
care. They have a government program that covers everybody. But I 
venture to say if you looked at the waiting lists, if you look at the 
Government rationing, if you look at the delays that are involved, if 
you look at the Government improvement that is needed and so on, you 
find many of those people are coming to the United States as a last 
resort to get quality health care.
  If we emulate their systems, where are Americans going to go? What 
kind of fallback do we have? The Canadians are coming south. They come 
into the United States to get health care if they really need it.
  The doctor says, ``You need a bypass but we have already had our 
quota. You need it within 6 months or 12 months. We know you are going 
to need it. We will get around to it, but we cannot do it in this 
Province now. This is in the fourth quarter of the year and, frankly, 
we are about out of money. So, elective surgery, we have said, in this 
Province in Canada, we are going to postpone until next year.''
  A lot of people might not be willing to take that risk so they come 
to the United States. If we get into that scenario, where would 
Americans go?
  So I just make a final plea that we do no harm. Let us seriously 
consider the legislation we have before us. Let us take a look at it. 
Let us look at all the proposals and pass positive legislation. At the 
same time, let us not pass legislation that we are going to regret.
  I was very involved in the debate--which was a few years ago--the so-
called catastrophic health insurance for senior citizens that was going 
to provide catastrophic coverage. Basically, although we called it 
catastrophic, really it was a medigap policy. Medicare paid for some, 
but it did not pay for some of the deductibles. We said we will have a 
policy to cover that. And a lot of people already had it; actually 75 
percent. Senior citizens had medigap policies through the private 
sector. Congress came in and said we do not care if you have it or not, 
some people do not, so we are going to mandate it on everybody.
  We mandated a Federal program on all senior citizens, whether they 
wanted it or not. We did not give them an opt-in or opt-out. I might 
mention we passed it in the Senate and we did make it voluntary, but 
when it came back from conference, it came back mandatory for everyone.
  I debated a couple of hours on that legislation, debated against our 
friend and colleague, now Secretary of the Treasury, Senator Bentsen. I 
said this is moving in the wrong direction. Why do we not target our 
efforts at the 25 percent of senior citizens who do not have Medigap 
policies and then target the portion of that one-fourth of the senior 
citizens group who did not have it and could not afford it? Some people 
did not want it who could afford it. Why should we have a Federal 
program to cover them? We did not need to.
  But no, we did not do that. We did not put a means test on it. What 
we did do is have a big tax increase. We are going to cover everybody. 
We do not care if you have private coverage or not, we are going to 
duplicate it with a Federal program and pay for it with a Federal tax. 
And at least the Finance Committee was honest and direct and said this 
is going to be a tax; this is going to be a 25-percent surcharge on 
your income tax.
  I predicted on the floor when we were debating that that when the 
bill comes due, senior citizens are going to rebel, and they did. 
Because they rebelled, we repealed it a year later, and I think 
correctly so.
  I hope we do not make that same mistake in this legislation, but I 
also hope that we are very direct with the American people. I think we 
ought to tell people what it is going to cost. We ought to tell people 
what is in the legislation. We ought to do it now before we pass it, 
not after we pass it and find out, ``Oh, I didn't know that was in the 
legislation.'' We ought to do it now. We ought to find out what is in 
the legislation.
  Some of us have complained about this process. I have complained 
about the process and, I will say, going back from the moment of its 
conception within this administration. The process started out very 
partisan. Mrs. Clinton and President Clinton put together a task force 
of over 500 people. They met. Now it appears they met illegally and 
there is a lawsuit pending. I notice there was an article in the New 
York Times on Wednesday, August 10. It talked about the ``White House 
Seeks Settlement of the Health Suit.''
  They have been sued and, frankly, it looks like they are going to 
lose. I will not read the entire article, but I will insert it in the 
Record.
  It says:

       The Clinton administration urged a group of doctors today 
     to agree to a swift settlement of their lawsuits seeking 
     disclosure of the records and working papers of Hillary 
     Rodham Clinton's task force * * *
       For more than a year, the White House has resisted 
     disclosing the records. But administration officials said 
     today they wanted the lawsuit settled as soon as possible, in 
     part to avoid the need for having Mrs. Clinton and Ira 
     Magaziner, a White House aide who coordinated the work of the 
     task force, to testify.
       The 12-member task force and its staff of more than 500 
     developed most of the President's proposal to control health 
     care costs and guarantee health insurance for all Americans. 
     Major parts of the proposal have been incorporated in the 
     legislation developed by the Democratic leaders of the Senate 
     and House, Senator George Mitchell and Representative Richard 
     Gephardt.

  And it goes on in the article. I will just read the last part:

       The groups contend--

  Talking about Mr. Magaziner.

     that he was wrong when he said in an affidavit in March 1993 
     that all members of the staff of the task force were 
     Government employees. In fact, the three groups said, many 
     staff members came from business in the health care industry 
     that stood to profit from the President's plan.

  Mr. President, I am troubled that Presidential adviser, Mr. 
Magaziner, who coordinated the task force, testified in an affidavit, a 
sworn statement, that these were all Government employees if they were 
not. If you had special interest groups who were writing this package 
and putting a lot of this together--and I am going to mention this in 
my speech a little later--if they were doing that against the law, that 
bothers me, and it bothers me that he would sign an affidavit saying 
they were all Government employees if they were not.
  I know the Presiding Officer, the chairman of the Appropriations 
Committee and President pro tempore, believes people should speak the 
truth. I am bothered by Mr. Altman's statements before the 
congressional committee. I am bothered anytime anybody deliberately 
misleads Congress and does not state the truth, particularly when they 
are in high levels of power, or abuses that power, and particularly if 
they are trying to pass legislation or implement legislation that would 
have a significant impact on my constituents.
  I see a lot of things in this bill that I am very troubled by. Where 
did they come from? We have not had a hearing on this bill. I am 
troubled by the process of where we are.
  Mr. President, I ask unanimous consent that this article be printed 
in the Record.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

                [From the New York Times, Aug. 10, 1994]

              White House Seeks Settlement of Health Suit

                            (By Robert Pear)

       Washington, Aug. 9.--The Clinton Administration urged a 
     group of doctors today to agree to a swift settlement of 
     their lawsuit seeking disclosure of the records and working 
     papers of Hillary Rodman Clinton's Task Force on National 
     Health Care Reform.
       For more than a year, the White House has resisted 
     disclosing the records. But Administration officials said 
     today that they wanted the lawsuit settled as soon as 
     possible, in part to avoid the need for having Mrs. Clinton 
     and Ira C. Magaziner, a White House aid who coordinated the 
     work of the task force, testify.
       The 12-member task force and its staff of more than 500 
     developed most of the President's proposal to control health 
     costs and guarantee health insurance for all Americans. Major 
     parts of the proposal have been incorporated in the 
     legislation developed by the Democratic leaders of the Senate 
     and the House, Senators George J. Mitchell and Representative 
     Richard A. Gephardt.


                        negotiations accelerate

       Justice Department lawyers asked the plaintiffs to start 
     discussing the possibility of a settlement last Thursday, and 
     the negotiations have accelerated this week. The Government 
     appears to be willing to disclose thousands of pages of task 
     force records, but has been reluctant to pay lawyers' fees 
     for the plaintiffs' lawyers.
       It is not clear why the Administration is so eager to reach 
     a settlement this week, although the Administration 
     apparently wants to announce a settlement before Congress 
     takes any votes on health care legislation. In addition, the 
     Administration may also want to make sure that Republicans 
     cannot use the litigation in political attacks on the White 
     House.
       The plaintiffs in the case, including the Association of 
     American Physicians and Surgeons, have repeatedly asserted 
     that ``special interests'' from the health care industry 
     influenced the task force at meetings from which the public 
     was excluded. The White House has rejected those assertions.
       On July 25, the Administration told a Federal judge that 
     the President's health plan had been devised by ``an 
     anonymous horde'' of more than 500 people operating in 
     creative confusion with no organized structure and no fixed 
     roster of members. As a result, the Justice Department 
     asserted, the task force was not a formal advisory committee 
     and did not have to divulge its working papers or financial 
     records.
       The Judge, Royce C. Lamberth of the Federal District Court 
     here, said last month that he would hold a full trial to 
     examine the composition and operations of the task force. The 
     trial would determine whether the panel and its staff 
     operated legally in excluding the public from meetings from 
     January to May 1993, when it was disbanded.
       The plaintiffs, three groups of doctors and consumers, have 
     also asked the judge for a contempt citation against Mr. 
     Magaziner.
       The groups contend that he was wrong when he said in an 
     affidavit in March 1993 that all members of the staff of the 
     task force were Government employees. In fact, the three 
     groups said many staff members came from businesses in the 
     health care industry that stood to profit from the 
     President's plan.

  Mr. NICKLES. Mr. President, I am concerned about the legislation we 
have before us. I read a lot. I took home the first print, and it was 
1,400-some pages. I worked on it. I had my yellow magic marker. I was 
going through pages, as hard as I could, and I was marking pages. I was 
putting question marks down.
  I have studied legislation a lot. I have introduced legislation. And 
I know it is not easy, and I know it is not simple. But last Monday, I 
believe, was the first day we had the first print. We call it the 
Mitchell-Clinton print 1. Then there was 2. Then there was 3. I am not 
sure if this is the amendment or notification of the second or third, 
but it has over, I think, 133 sections that were changed. I believe 
that is between the first print and the second print.
  All it mentions is the section number and a change. ``These following 
sections have been modified since initial printing.'' I was working off 
the initial printing. Mr. President, I invested a lot of hours on that 
initial printing, the first one that came out. I wanted to know as much 
about it as anybody. I signed a little card saying I am going to read 
this bill before I vote on it favorably, and I am going to. Now we have 
another bill. We have to start over.
  There are over 100 sections that have been changed. What is in this 
bill? Was it reported out of the committee? No. Was this bill reported 
out of the Finance Committee? No. Was it reported out of the Labor 
Committee? Has there been a hearing on this bill? No. Does anybody 
really know what is in this bill? Maybe a few staff members; maybe some 
of the White House advisers. I am not sure. But I know there is a lot 
of garbage in the bill. There are a lot of provisions in the bill, in 
my opinion, that would be very, very negative.
  Again, I said let us do no harm. Let us make sure that whatever we do 
does no harm.
  I have listed several little things--I call them little things, I 
think they are rather significant--provisions in the Clinton-Mitchell 
bill that, in my opinion, are very bad. I want to talk about them just 
a little bit. I will go through each one.
  First, it denies consumer choice. I know I heard my colleague and 
friend, Senator Mitchell, say this bill is a voluntary system. I know 
if you read section 1003, it says ``Protection of Consumer Choices.'' 
It makes you think you can keep your own plan. I will just run through 
this.
  This bill imposes a one-size-fits-all benefit package on all 
Americans. That means people in West Virginia have to buy the same plan 
that people in Oklahoma buy or in New York City. The Government is 
going to define the benefit package for everybody in America. So if you 
want to have a little less, something a little more affordable, that is 
not an option. So you lose a lot of choices.
  It imposes $300 million in new taxes. That is CBO's figure. Dr. 
Feldstein mentions it is $100 billion per year. I will talk about that 
in a minute.
  It hurts the middle class.
  It imposes a hidden tax on the young, a big hidden tax.
  It results in substantial job losses. If you put this kind of 
mandate, this mandate, some people say, if it happens--and I guarantee 
you, in a lot of States that have 80-some percent of coverage, you are 
not going to get to 95 percent coverage under the terms of this plan, 
so you are going to have a mandate--that mandate will cost jobs.
  It creates big incentives for people not to work. People are going to 
realize, ``The Government is going to be providing this.'' We are going 
to be more than doubling the size of Medicaid. I wonder if people 
realize that. I know the chairman of the Appropriations Committee has 
wrestled with expansion of entitlement plans, the fact that Congress 
actually has less and less control over the Federal budget because we 
pass programs that grow on automatic pilot; that under the Clinton-
Mitchell bill, we will have a massive expansion of people eligible to 
receive Federal assistance called subsidies. By the year 2004 there 
will be 117 million people subsidized under this proposal. That is a 
massive expansion and more than doubles the Medicaid population or 
people eligible to receive assistance from the low-income side.
  It creates an enormous bureaucracy--some people have already talked 
about this, so I will try not to be too repetitive--over 250 new 
bureaucracies in boards and commissions, some of which are very, very 
powerful. Some of them have enough power to say this benefit will be 
covered and this benefit will not. Some will say we need cost 
containment and, therefore, this agency or commission is going to do 
something to contain costs.
  Does that mean price controls? In all likelihood, it would.
  It creates a huge new entitlement program, actually several new 
entitlements programs. I will touch on that in a moment.
  It vastly increases the number of people on governmental assistance.
  It promotes and subsidizes abortion. I know I heard Senator Dole and 
others say we are going to have to talk about this for a while. There 
is no status quo on abortion. This is a program that says we are going 
to subsidize abortion, whether you want to or not. We are going to have 
the Federal Government pay for it. We do not do that today under our 
Federal system under Medicaid. We have passed language for years, and 
we call it the Hyde language. Basically, it says we are not going to 
use Federal money to pay for abortions unless it is necessary to save 
the life of the mother, or in cases of rape or incest.
  This says, no; this is a fringe benefit and pays for everything. And 
it also says you have to have access to abortion everywhere in the 
country. I would say in West Virginia, and in 80 percent of the 
counties in the country, they do not provide abortion. This is going to 
mandate that every place in America or every person in America have 
access to the whole list of standard benefits coverage, including 
abortion. It massively promotes and subsidizes abortion throughout the 
country.
  It also caters to special interests. And by special interests, I am 
talking about the AARP. I will talk about some provisions that were 
written, in my opinion, probably specifically for AARP, and for 
organized labor. They are getting a lot of support from those groups as 
well as from the groups that support and promote abortion.
  It would even have some language, I will tell the Presiding Officer, 
that expands civil rights statutes to include protection for sexual 
orientation. That is interesting. Most people are not aware of that, 
but it is in the bill.
  And it has no real malpractice reforms. Frankly, the bill, instead of 
having positive malpractice reform, would override about 20 laws that 
are on the books that try to limit abuses in the cost of providing 
limitations on insurance costs. It overrides those. It does more harm 
than good. And I think that is a serious mistake.
  Mr. President, while I am going through the Mitchell-Clinton bill and 
trying to describe some of the things I think that are wrong with it, 
let me just state at the outset, again, I want some positive health 
care reform. I want to cover preexisting illness. I want to make sure 
that people do not lose insurance if they become ill. I want 
portability where people can take their insurance from job to job or 
have control of insurance.
  I think one of the big problems we have today in health care is that 
individuals, the people who buy, the consumers, are not really at the 
table. Somebody else is paying for it--well, Government is paying for 
it or the employer is paying for it. So they do not care how much it 
costs.
  I think the individual should have some responsibility, and, 
unfortunately, the Clinton-Mitchell bill, the Gephardt bill, President 
Clinton's original proposal move just the opposite direction. Instead 
of having individual responsibility, they make more people dependent. 
Instead of giving individual rights and choices, they have the 
Government making those decisions.
  Mr. President, let me just start out by stating I think it is vitally 
important that all people always give the facts and tell the truth all 
the time. I am bothered by this statement. This was in the President's 
statement just recently, August 3. He said: ``You can keep your own 
plan or pick a better one.''

  Well, that is not accurate, and it is unfortunate to have the 
President of the United States say you can keep your own plan or pick a 
better one, but he is not telling the complete truth, in my opinion, in 
that statement. And that bothers me a lot.
  Let us just take this first part: ``You can keep your own plan.'' Let 
me just give you an example. I hate to use personal examples, but I 
know not one better.
  I used to run a company, Nickles Machine Corporation. We had a plan. 
Can I keep our plan? No. Why? Because we self-insure. Under the 
President's plan, firms that have fewer than 500 employees cannot self-
insure. So the President's statement is false as far as Don Nickles and 
Nickles Machine. We cannot keep our own plan because, under the 
Clinton-Mitchell bill, it says, if you self-insure and you have less 
than 500 employees, your plan is illegal. You cannot self-insure.
  I think that is really wrong. I think self-insured plans have a lot 
to offer. We have been able to get our costs down, and we are able to 
do it a lot less expensively than the President's plan. I am bothered 
by that.
  I mentioned the cost. I will just pull that out. One of the reasons 
why some people self-insure is they can do a better job for less 
expense. Under the Clinton-Mitchell package, the cost for a family 
estimated by CBO--these are 1994 dollars, and you know it will be 
higher later--is right at $6,000 for a two-parent family--$6,000. They 
are going to mandate that or tell everybody, if you are going to have 
insurance, here is what you have to have. They have a standard benefit 
plan that tells you you cannot buy something less.
  In other words, in this little bill--it just happens to be section 
1201 and 1202, I believe, unless they changed the sections on this, 
too. Oh, yes, ``standard benefit package.'' ``General description. 
Standard benefit package.'' Then they have given enormous power to the 
National Health Benefits Board, which is section 1211 through 1217. 
This board is going to determine what has to be in everybody's plan. 
And we give them about 20 pages that says what Congress says it should 
be in this plan, and it has a lot of coverage, a lot of coverage you 
may want, maybe coverage you do not want. I mentioned it has abortion. 
You have to have it in your plan whether you want it or not under this 
bill--no opt out, no choice, no conscience clause or anything. It says, 
you have to have it.
  I object to that. I object to it on moral grounds, but I object to 
Government thinking they have to define every package in America. What 
in the world makes some of our colleagues and this administration think 
that they can design a health care package better than anybody else in 
America? What in the world gives them the right or the power to think 
they know best in what should be in everybody's health care plan? And 
we are not talking about a core benefits package. We are not talking 
about a minimal benefit package, just the bare essentials so that 
people just get by, something very economical.
  No, we are talking about a comprehensive, extensive, expensive 
benefit package that lots and lots of people in America will not be 
able to afford. And they are going to mandate. It is mandated under 
President Clinton's original proposal, it is mandated under the 
Gephardt proposal, and it will be mandated under the Clinton-Mitchell 
proposal because we will not get to 95 percent. Maybe we will, but I 
doubt that we will. I know in a lot of States we will not get there.
  To give you an example, I have heard people talk about Hawaii. Hawaii 
had 90 percent coverage before they went to an employer mandate. And 
now they have massive subsidies. They have 20 years under an employer 
mandate and they got up to 94 percent. They are still not up to 95. So 
I have some questions.
  I know CBO says they think they can make it. I think they are doing a 
little wishful thinking. I think under Senator Mitchell's package those 
mandates are going to happen and there are going to be consequences to 
those mandates.
  I might mention, too, looking at the rest of these premiums, for a 
single adult, the cost of that plan is $2,200. That is pretty 
expensive. It is especially expensive for young, single adults, and I 
might mention that as well.
  Well, again, going back to President Clinton's comments, he said: 
``You can keep your own plan or pick a better one.''

  I just noticed, under the President's bill--I hope people look at 
it--if you have a cafeteria plan--and I know there are some unions in 
West Virginia that have cafeteria plans where you choose from a 
multitude of benefits--health care cannot be in a multitude or menu of 
benefits. I think cafeteria plans are great because you are putting 
consumers at the choice: Do you want to spend more money on health care 
or do you want to spend more money on vacation? Do you want to have 
more money to take home? You get to choose from a multitude of fringe 
benefits where employees then recognize the cost of health care. That 
is a good benefit for putting people at the table to recognize the 
benefits.
  Those are outlawed under the President's plan. You cannot keep your 
own plan if you have a cafeteria plan in health care.
  Wait a minute, Mr. President. You said on August 3 you can, but you 
cannot. He did not tell the truth. That is not the case. And that 
bothers me. Those plans are illegal under this bill.
  The flexible spending accounts, which a lot of Americans have today, 
health care is not included in those flexible spending accounts. Again, 
millions of people have these types of plans.
  In the cafeteria plan, well, just by changing this tax and not 
allowing health care in, they estimate, will raise $52 billion in 10 
years. So we are talking about lots of employees, lots of individuals 
are going to lose that. They are going to lose flexible spending 
accounts. Again, a lot of people have that today. They are not going to 
be able to have it tomorrow.
  What about the people who have a high-cost plan and maybe these are 
union plans, maybe they are plans people have and they are designed and 
very generous.
  The President says you can keep your own plan. What he did not tell 
you, there is a big tax on that plan, a 25-percent tax surcharge.
  Well, wait a minute, you are not going to be able to keep that plan 
probably if you find out it is going to cost you 25 percent more. Think 
about that. And so maybe legally you could keep it, but the real 
results are economically, if you find out there is a tax surcharge on 
it of 25 percent, you are not going to keep it. And you have a lot of 
union plans, you have a lot of other plans in the country today, if 
they happen to be a little bit better than average, anything that is 
above that average that is determined by a beautiful bureaucratic 
disaster formula, they are going to have a big tax, a 25-percent tax. 
So the Tax Code is going to take away that nice benefit they have 
because people are going to design their plans away from it.
  What about if you have a plan that does not conform to the Government 
plan?
  I mentioned one-size-fits-all. What if you say, No. I don't believe 
in the one-size-fits-all in the Government package. We have a good 
package, and we are happy with it and we think we can do it more 
economically. I am going to opt out.
  I heard Senator Mitchell say this is voluntary. If this is voluntary 
in Nickles Machinery, since I am still involved, we opt out. I do not 
want any part of it. If it is voluntary, throw it away, and our 
employees are happy. Guess what? We can do it for $2,400 per family, 
not $6,000 per family. So I opt out.
  What happens to us? If you do not conform to the standard benefit 
package, there is this 35-percent tax. Wait a minute. Think about that 
again. President Clinton said you can keep your own plan. He did not 
tell you that, if you keep your own plan, there will be a 35-percent 
tax if you did not conform to the Government standard benefit package. 
How can you keep your own plan, if you have a 35-percent tax?
  Let us just assume that you have a plan that does not conform to the 
standard benefit package, but your plan is more generous. That is 
possible. You could have a tax surcharge because you do not conform, 
and you could have a 25-percent tax surcharge for excessive cost. That 
is a 60 percent additional marginal tax on the health insurance dollars 
because you said you do not want to play.
  They said it is voluntary. Yes. It is a voluntary, with a gun at your 
head; big taxes; 25-percent tax if you have an expensive plan, and 35 
percent tax if you do not conform.
  You do not get to keep your own plan. It is not right. So you lose 
your cafeteria plan, your flexible spending account. If you have an 
expensive plan, you will be taxed for that. If you do not conform, they 
will tax you.
  It has massive taxes in it. But they use the Tax Code to drive their 
idea that Government will control it. They will design your plan. This 
National Health Benefits Board will say what your plan is.
  I know that most of our colleagues are not going to read this bill. I 
hope that they will just take a little time and read the powers that we 
have granted to the national health benefits board. That is just one of 
50 new boards and commissions that are set up and have so much power.
  I urge the Presiding Officer, it is not that many pages to read that 
one section. If we can get other colleagues to read about some of the 
powers that we are giving to this board and the cost containment board; 
enormous powers. If they make recommendations, we are telling Congress 
or future Congresses that we are going to consider this legislation on 
an expedited basis, in some cases without the right to amendment, and 
in some cases without the right to filibuster.
  So here is this board, a seven-member board appointed by the 
President. It outlines all of that in here; a seven-member board with 
all this power to make their decisions. And then they are going to tell 
Congress we need legislation. Congress has to consider that legislation 
on an expedited basis without extended debate. That limits your right 
to amend it.
  I know many of us feel we should have that right. Why in the world 
should we pass legislation today that is going to take away that right 
and obligate future Congresses? Not everybody is going to be here 5 
years from now. I may or may not be here 5 years from now, I don't 
know.
  I am bothered by trying to pass a law that is going to restrict 
future Congresses as this bill would propose. I think that would be a 
serious mistake.
  This imposes new taxes. I mentioned a few of them; $300 billion in 
new taxes. I mentioned a couple of the taxes that are used as a hammer 
to make everybody conform. I hope people look at those because I know 
when I have heard taxes, I heard most of my colleagues mention the fact 
that, well, there is a tax of 1.75 percent tax premiums. That is going 
to drive excess premiums up in America.
  So if you want to get health care costs down, this bill is not going 
to do it. It is going to drive them up. It is almost a 2-percent 
increase on every premium in America. So that means the costs are going 
up considerably.
  If you have a health care plan that provides benefits that are more 
generous than what this commission says is appropriate, there will be a 
25-percent tax. I might mention the tax is basically on incremental 
increases.
  So if you have a pretty economical plan, and I mentioned that at my 
company it is $2,400. If we have to provide now this standard benefit, 
that will maybe cost about $6,000, as we increase. We will probably 
have to increase pretty rapidly. We are going to get hit with that 25 
percent tax. If we have been more frugal, and more economical, we will 
be penalized. The more generous you have been and the more economically 
inclined you are, the more you will be taxed. This is a very 
interesting provision which I think is seriously wrong.
  Mr. President, I heard some people who were discussing this bill say, 
``No. It has only four new taxes.'' There are 18 new taxes. I will not 
go through all of those. But I will put them in the Record so everybody 
can see them.

  I cite code numbers, and the section number. Of course, they have 
changed bills on me three times. We are trying to put the latest code 
numbers in.
  I mentioned premium tax, and excise tax. There is a big tax on part B 
premiums for upper-income people. There is an increase of 15.3 percent 
on the tax of income of certain S corporation shareholders and 
partners. There is a 2.9-percent health insurance payroll tax on all 
State and local work; Medicare coverage to such workers. They include 
employee income for Federal income and payroll tax purposes, and none 
is permitted for employer-provided health care coverage other than the 
standard benefit package and certain supplemental coverage.
  So you have something that is not permitted under this standard 
benefit package. You are going to be taxed. Individuals are going to be 
taxed. They need to know it now. They need to know what is in this 
package now, not after it passes. They need to find out before it 
becomes law.
  They are going to include employee income subject to Federal income 
payroll taxes for Federal benefits provided through a cafeteria plan 
for the flexible spending account. There are millions of people who 
have those benefits. They will now be taxed. They are going to lose 
those benefits because they are losing that tax incentive. We have not 
taxed health care costs in the past. But now, if you have that type of 
plan where an employee gets to choose what type and size of benefit 
they have, they are going to be taxed.
  They place a limit on the deductibility of insurance for health 
insurance made in advance. I have already mentioned they impose a 35-
percent tax, nondeductible excise tax on employer-sponsored plans that 
do not conform to the standard benefit plan.
  So again I go back to President Clinton who says that you can keep 
your own plan. You can, but you will pay a 35-percent tax if you do not 
conform to this plan, to this commission.
  They make the decision and decide what benefits you should have or 
your employees should have. It is not you who decides it.
  The reason I introduced the consumer choice bill is because I thought 
consumers should make that decision. They should not decide. You 
should. You know what is right for your family. I know what is right 
for my family, not some governmental panel that is also involved in 
social policy and other things. I want to buy what is the best deal. I 
want a good buy for my family. If I could it to for $2,400, or less, I 
want to do it. I am troubled by these costs because I will tell you, 
there are a lot of families that cannot afford $6,000 per year. I know 
others say, ``Wait a minute. They subsidize those.'' I say this bill 
really hurts the middle class because maybe they have insurance 
policies but now they will be taxed. Maybe they have insurance policies 
but they cannot buy cafeteria plans because they have to pay a premium 
tax. So the premium is going up by 2 percent. It is a big hit.
  There is a hidden tax on the young. This is close to my home because 
I have four kids. I have a 24-year-old son. He is out of the home and 
on his own. I need to check with him about what his premium is. I know 
what my daughter's is. She turned 22, is still at home and not out on 
her own. She has a supplemental policy, and she is not on the family 
plan. It is about $500. I think it is $40 a year at the university, and 
that is not a great plan. It covers my daughter. It is going to cover 
us if she has a serious problem. Most of those cover serious problems, 
but not everything.
  CBO has scored the Mitchell bill at $2,200 per adult. My daughter is 
an adult. It would quadruple her premium. That is a hidden tax, an 
increase on my daughter of $1,700. She cannot afford it. Frankly, I 
would pay that insurance bill. She is not on her own. My son is on his 
own. Maybe he can afford it now. There are a lot of 24-year olds, and 
28-year-olds that cannot afford $2,200. They should not have to pay 
that. They should be able to buy another plan, if they can. Maybe they 
are young and healthy. Maybe they are not going to the hospital, or 
maybe they will not see a doctor. They should not have to pay over 
$2,000. But under the Mitchell bill they have to. We have community 
rating, and that is a serious mistake. It is a hidden tax.
  Mr. President, I want to insert in the Record an article by Martin 
Feldstein who worked in the previous administration, and he talks about 
the tax increase in the Mitchell bill. It is entitled ``A Hidden $100 
Billion Tax Increase.'' Most of the figures we use are over a 10-year 
period of time. There are $300 billion in new taxes over a 9- or 10-
year period of time.
  Dr. Feldstein is talking about $100 billion tax increase--that is per 
year, and these are direct taxes as scored by CBO. He adds that the 
hidden taxes are in community rating, which is in the Clinton bill.
  I ask unanimous consent to have this printed in the Record at this 
point.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

              [From the Wall Street Journal, Aug. 9, 1994]

 The Senate's Health Care Follies.--A Hidden $100 Billion Tax Increase

                         (By Martin Feldstein)

       President Clinton is increasing the pressure on Congress to 
     enact a massive and irreversible entitlement program to 
     subsidize health insurance and redistribute income. The tax 
     cost for this largest-ever welfare expansion would top $100 
     billion a year at today's prices. That's equivalent to 
     raising personal taxes across the board by nearly 20%.
       Amazingly, the Senate Democratic leadership has managed to 
     conceal this massive tax increase from the public. The 
     legislative wrangling and public discussion have virtually 
     ignored the cost of financing this spending explosion. 
     Members of the business community have been so eager to avoid 
     employer mandates that they have not considered the tax 
     consequences of the pending legislation. And members of the 
     general public have been so concerned about preserving their 
     ability to choose their own doctors that they have not 
     focused on what these plans would mean for their individual 
     wallets.


                              cbo analysis

       Although the Democrats have yet to agree among themselves 
     on the details of the final plan, it is likely to be closely 
     related to the Senate Finance Committee bill. (The recent 
     proposal by Senate Majority Leader George Mitchell that 
     President Clinton said he would accept is essentially an 
     expanded version of the committee's plan.) To understand the 
     magnitude of the potential tax hike that would be required to 
     finance such a plan, it's useful to look at the Senate 
     Finance Committee bill and the recent analysis of it by the 
     Congressional Budget Office.
       Under the Senate Finance Committee plan, the government 
     would pay the full cost of a standard private insurance 
     premium for anyone below the poverty level and would provide 
     a partial premium subsidy that declines with income between 
     the poverty level and twice that income. The insurance 
     premium would vary with family composition but would average 
     about $2,000 per person. A single parent and child would 
     receive a subsidy with income below $20,500, while a couple 
     with three children would receive a subsidy with income up to 
     $37,700.
       More than 60 million individuals would be eligible for 
     subsidies in addition to the 60 million already covered by 
     Medicaid and Medicare. The Senate Finance Committee plan 
     would raise insurance coverage by about 21 million 
     individuals, bringing total coverage to 93% of the American 
     population.
       The budget analysis prepared by the CBO never states its 
     estimate of the total additional cost that taxpayers would 
     have to bear to finance the new insurance subsidies. But the 
     CBO figures do imply that the public would be paying about 
     $63 billion a year (at 1994 prices) by the year 2000 when the 
     plan is fully operational, and estimates that I have made 
     with the help of colleagues at the National Bureau of 
     Economic Research indicate that the CBO figures understate 
     the true cost by about $40 billion a year.
       Most of the $63 billion tax burden implied by the CBO 
     numbers is hidden in cost-shifting through insurance 
     companies and providers of health services. Only a relatively 
     small part of the financing plan is an explicit increase in 
     the tax on tobacco products. A second small piece is a 1.75% 
     excise tax on private health insurance premiums. Although 
     this tax of $7 billion a year (at 1994 levels) would be paid 
     by the insurance companies, they would pass it on in the form 
     of higher premiums.
       These higher premiums would be a direct tax on individuals 
     who buy their own insurance. Companies would offset the 
     higher premiums on the insurance that they provide to their 
     employees by keeping wages lower than they would otherwise 
     be. The true burden of the premium tax would therefore fall 
     on everyone who is now privately insured.
       The largest part of the financing is a hidden tax that is 
     built into the plan to replace the current Medicated program 
     for the poor by substalized private insurance. Medicaid 
     provides much more generous benefits than the proposed 
     standard insurance package, since Medicaid covers a broader 
     range of services and has no out-of-pocket copayments. 
     Although the government would pay the insurance companies the 
     same subsidies for former Medicaid beneficiaries as it pays 
     for everyone else, the proposed law would require the 
     insurance companies to provide those who are currently 
     eligible for Medicaid with the much more expensive coverage 
     that they have today.
       That complex maneuver would save the government about $29 
     billion a year on the current Medicaid program and would add 
     that amount to the annual costs of the Insurance companies. 
     The insurance firms would in turn shift it to everyone who is 
     privately insured in the same way they would shift the 
     explicit premium tax.
       A second very large hidden tax would result from reducing 
     government payments to hospitals and other providers of 
     Medicare services without any reduction in the care that they 
     are expected to give. As a result, the hospitals and other 
     providers would just raise their prices to patients and 
     insurance companies. In the end, it would be the privately 
     insured individuals who bear those costs in the form of 
     higher insurance premiums and lower wages. At 1994 levels, 
     this, cost-shifting burden is equivalent to at least a $13 
     billion annual tax.
       In short, buried in the CBO numbers is a projection that 
     the Senate Finance Committee plan would have a $63 billion 
     annual cost (at 1994 price levels) and that all but what the 
     CBO estimates to be $14 billion in cigarette levels would be 
     obtained by hidden taxes in the form of cost-shifting through 
     health care providers and insurance companies.
       It's remarkable that the same politicians who have produced 
     this $49 billion in hidden cost-shifting have the audacity to 
     say that the public should support their plan in order to 
     eliminate the much more limited cost-shifting that occurs 
     under the existing system as hospitals pass on the cost of 
     free care. Indeed, to the extent that hospitals are already 
     giving free care, the increase in formal insurance coverage 
     gives that much less to the currently uninsured and confirms 
     that most of the plan's cost is to achieve income 
     redistribution, not expanded health insurance.
       The CBO report is careful to note that its estimates are 
     ``preliminary'' and ``unavoidably uncertain,'' and fully half 
     of the report is devoted to discussing why there is ``a 
     substantial chance that the changes required by this 
     proposal--and by other systemic reform proposals--could not 
     be achieved as assumed.''
       My own analysis confirms that the CBO's caution is 
     justified and that the CBO estimates understate the likely 
     annual cost by at least $40 billion that would eventually 
     have to be financed by higher taxes. A key reason is that 
     there is no way to limit the premium subsidies to those who 
     are currently uninsured. Those who are not buying their own 
     insurance would automatically receive the government subsidy. 
     Those who now receive insurance from their employers could 
     qualify for an insurance subsidy by switching to an 
     employment situation that paid higher cash wages instead of 
     providing health benefits.
       That subsidy would be worth a very significant $2,000 for a 
     single mother with a child who earns $15,000; if she earns 
     $10,000, the subsidy would be worth more than $4,000. It 
     wouldn't take long for employers and employees to recognize 
     that some combination of new pay arrangements, explicit 
     outsourcing of some work, and individual job changes would be 
     handsomely rewarded by the government.
       There are now more than 30 million individuals who could 
     qualify for a subsidy. The CBO estimate recognizes that the 
     roughly six million of them who now buy their own insurance 
     would receive government subsidies. But when it comes to 
     those who are already insured by their employers, the CBO 
     assumes that only about one-fifth of the income-eligible 
     group would eventually choose to qualify for the subsidy, 
     leaving $27 billion of potential subsidies (at 1994 levels) 
     on the table. It seems totally implausible to me that 
     employees and employers would permanently pass up subsidies 
     of $1,000-plus per person that they could get by relatively 
     easy changes in employment arrangements. When they do choose 
     to qualify, taxpayers would have to pay an additional $27 
     billion to finance the plan.
       The CBO calculation also ignores the effect of the subsidy 
     phase-out between poverty and twice poverty on the incentives 
     to work and to report earnings. The phase-out rule that gives 
     a women with a child $4,660 of subsidy when she earns $10,250 
     and then takes away more than 40 cents of subsidy for every 
     extra dollar that she earns is a powerful incentive to work 
     less and to shift work to the underground economy.
       The CBO's report acknowledges that ``the effective marginal 
     levy on labor compensation could increase by as much as 30 to 
     45 percentage points for workers in families eligible for 
     low-income subsidies'' so that ``some low-wage workers would 
     keep as little as 10 cents of every additional dollar 
     earned.'' But then, quite incredibly, the CBO calculations do 
     not take into account that this would reduce reported 
     earnings, thereby cutting income and payroll tax receipts and 
     raising the health insurance subsidies for which individuals 
     are eligible. Estimates made at the NBER indicate that these 
     reactions would reduce taxes and increase subsidies by a 
     combined total of at least $17 billion a year.
       This estimate makes no allowance for the impact of 
     increased demand on health care costs in general. Extending 
     insurance to at least 20 million people who are currently 
     uninsured and giving private insurance to the more than 25 
     million nonaged Medicaid beneficiaries would inevitably raise 
     the demand for health services and increase health care 
     prices. But even without that, the analysis that I have laid 
     out shows that the Senate Finance Committee bill would cost 
     the American public more than $100 billion a year at today's 
     prices. The Clinton-Mitchell plan for even broader coverage 
     would cost even more.


                         income redistribution

       A cost of $100 billion-plus a year to increase the number 
     of insured by 20 million means a cost to the taxpayers of 
     more than $5,000 for each additional person insured--a cost 
     of $20,000 for a family of four. Since the actual insurance 
     premiums are $2,000 per person, it's clear that most of the 
     tax dollars in these plans are for income redistribution 
     rather than the expansion of insurance coverage.
       The most fundamental social program in a generation should 
     not be enacted without full and careful consideration of its 
     costs. Once enacted, the benefits would be an irrevocable 
     entitlement for nearly 100 million people.
       The ability of the politicians to hide a $100 billion-plus 
     tax increase is both amazing and frightening. Using mandates 
     on insurance companies or mandates on all businesses as 
     substitutes for direct taxes destroys the budget process and 
     provides a ready way for politicians to deceive the voters. 
     The politics of tax and spend has entered a new era when 
     politicians can spend $100 billion a year and hide the taxes 
     that we pay for those outlays.
       If President Clinton and his congressional allies succeed 
     in ramming this legislation through Congress in the weeks 
     ahead, the American people will have lost not just $100 
     billion a year. We will also have lost our ability to check 
     the excesses of the political process and to unmask the 
     chicanery of the politicians.
       If political leaders want to deceive the voters, the only 
     safeguard is a democracy in which long and careful public 
     debate and congressional hearings can expose such deception. 
     Although Congress has held hearings on the now defunct 
     Clinton plan and on the broad issues of health care, there 
     has been no serious consideration of the cost and financing 
     of the plans that have recently emerged. The American public 
     deserves a chance to know what we are being asked to pay and 
     what we will get for our money. We should be suspicious of 
     any politician who says there isn't time for such a careful 
     examination.

  Mr. NICKLES. Mr. President, this bill would result in substantial job 
loss. That is very regrettable.
  Mr. WALLOP. Before the Senator leaves that issue, would he yield for 
a question?
  Mr. NICKLES. I would like to plow through, but go ahead.
  Mr. WALLOP. Well, there is another tax in here that is pretty 
ominous, and that is the 15 percent tax on every health plan premium in 
the State where the Federal Government takes over a system. This is the 
voluntary program, of course, but if the Federal Government does not 
like what the State has done, it takes over the system and applies 
another 15 percent premium tax on health care plans.
  (Mrs. FEINSTEIN assumed the chair.)
  Mr. NICKLES. I appreciate my colleagues' work. As I mentioned in my 
introductory remarks, the Senator from Wyoming has done great work in 
the Finance Committee in trying to inform people of the potential harm 
in some of the taxes. He also stated--and I did not mention this one--
there is also the provision that allows the States to have a tax on 
premiums as well. So you have a 1.75 percent Federal tax on premiums, 
but it says, States, you can tax the premiums, too; that power is 
yours. It results in substantial job loss. That is exactly right.
  Mr. President, I used to have a janitor service when I was working my 
way through school, and we did not provide health insurance for our 
employees. Our employees worked part time. Some were married. Under the 
Mitchell bill, a married couple with a child would be about $6,000. We 
had a couple of married couples in my janitorial service. The cost for 
that is about $4,400. I had single adults, students, which would cost 
me $2,200. I could not afford it, and they could not afford it. I know 
Senator Mitchell and others say, ``We are going to subsidize those 
people. We are going to provide them the same insurance everybody else 
has. We are going to subsidize them and take care of that problem so 
they do not need to worry.''
  I am on the Appropriations Committee and on the Budget Committee. We 
cannot afford that subsidy. We cannot afford to go down the subsidy 
trail that we are getting ready to take.
  I mentioned that it is going to cost jobs. If you do not have the 
subsidies--that janitorial service did not earn enough money to pay 
those kinds of premiums. So if you are going to mandate something that 
costs $6,000 per family, figure the hours and divide that out, and you 
are talking about increasing the minimum wage by over $2.60 per hour--
well, some of these jobs only pay a few dollars an hour. You are going 
to be pricing those jobs out of the marketplace. So not only will you 
not be giving people health insurance, you are basically passing a law 
that says unless you have a good enough income to pay minimum wage, 
other benefits and health insurance, which are enormously expensive, it 
is illegal for you to have a job. I will tell you that there are lots 
of jobs which some call menial jobs, sacking groceries, sweeping 
floors, or whatever--but I do not think any job is menial; I think it 
is preferable to no job. I would hate to pass laws in Congress that 
tell people it is against the law for them to have a job unless they 
meet a certain economic criteria. I would hate to pull that economic 
ladder up to where they cannot even get on it and climb that ladder. 
That is what we would be doing with the mandates.
  Some people would say this is a mandate on employers and, therefore, 
it does not cost individuals. I just totally disagree with that. You 
put a mandate that costs $6,000 on a family, and if an employer has 
insurance and says, ``OK, I cannot afford it, but I will go ahead and 
do it,'' I will tell you who pays for that; it is not the employers, it 
is the employees. They lose that money. That comes in the form of a pay 
raise that does not come or maybe in a direct reduction, but they will 
lose that money. So the employer mandate is 80 percent in the Gephardt 
bill, and it is 50 percent in the Clinton-Mitchell bill. It still comes 
out of employees' wages whether it is 20, 50 or 80 percent. If you are 
going to mandate that an employer has to provide this coverage, then 
you are looking at a very expensive provision that will cost employees. 
Does it cost employers? I doubt it. They will pass it on.
  I also noticed the majority leader saying, ``This is voluntary, we do 
not mandate anything on anybody.'' The company I used to manage 
provides health care, but we do it for a whole lot less than $6,000. So 
he is mandating that I provide a much more expensive health care plan. 
Eighty-five percent of the American people have health care insurance 
today, and maybe they can afford it, or barely afford it. But many have 
insurance that is a whole lot less expensive than this--$6,000. So 
maybe if they are paying $2,000, $3,000, you are going to mandate 
$6,000. That is a big increase. That is a hidden tax people have not 
talked about and that they have not looked at. If you mandate a 
Cadillac-type plan, or UAW-type plan, or AFL-CIO-type plan, a lot of 
businesses in California, Oklahoma, or wherever, cannot afford it. That 
is exactly what we are getting ready to do.
  My little janitor service could not afford it. So if you had this 
kind of mandate--unless you greatly subsidize it--we would say, no way. 
Some people would say, wait a minute, we are not going to do that 
unless you have less than 25 employees. I do not think that is in the 
Gephardt bill. It was not in the original Clinton bill. They said, ``We 
are just going to subsidize it.'' I am not looking for subsidies, and I 
know Congress cannot afford that.
  I have mentioned that it creates an enormous bureaucracy of 
entitlement programs. Most people are not aware, and they really have 
not focused on the cost and expansion of Government that is in the 
Clinton-Mitchell package. The new entitlements are enormous. Let me 
just touch on them. The entitlement program of subsidies for health 
insurance premiums creates more than $1.1 trillion in 8 years. I would 
like my colleagues to think about that. We have had various expansions 
also in Medicare, Medicaid, and so on, over the years. But nothing has 
ever been proposed as large and as expansive as the proposal we are 
debating today.
  This is a new entitlement program that will expand entitlements to 57 
million new people over the next 10 years. Think about that. Fifty-
seven million people will be receiving subsidies in 10 years that are 
not receiving subsidies today. That is more than doubling the 
eligibility of Medicaid. That bothers me. Where is that money coming 
from? It is going to be coming from taxpayers and, frankly, from senior 
citizens, because we take big reductions in Medicaid and Medicare to 
pay for these subsidies.
  So we are creating new entitlements, and we are going to have a 
subsidy program for unemployed, a subsidy program for women and 
children. We are going to have subsidies for anybody at less than 200 
percent of poverty. Well, 200 percent of poverty is about $30,000. So 
you are going to be subsidizing a lot of people. You are going to be 
subsidizing my daughter, and right now you are not. I pay for her 
insurance. It is $500, but you are going to be subsidizing her and 
charging her $2,200, when she can buy it for $500; but we are going to 
pay subsidies so she can help pay it. I would just as soon keep the 
Government out of it and let me buy her a $500 policy. We are going to 
mandate that she buy a $2,000 policy, and we are going to subsidize it 
and have the Government pay for it instead of the private sector, or 
myself, paying $500 as a family responsibility for my daughter. No, we 
are going to create a new Government program, and it will go up to 
$2,000. I think that is a serious mistake.
  Under the Clinton-Mitchell bill, they have subsidies that go all the 
way up to people making $44,000 a year, which is 300 percent of 
poverty. Well, they have children. That is nice, but not everybody that 
makes $44,000 needs a Federal subsidy, but they are going to be on the 
Federal subsidy rolls. Again, it is estimated that 57 million new 
people will be receiving entitlements under the Mitchell bill by the 
year 2004. That is a massive expansion of Government.
  So when I hear my colleagues say, ``Oh, we do not have a Government 
program,''--no? We are going to be subsidizing 117 million people under 
the Clinton-Mitchell bill. Let me repeat that. Again, these are not my 
figures. These are figures that came from CBO. They said by the year 
1997, only 3 years from now, we are going to be subsidizing 108 million 
people, and by the year 2004, 117 million people. CBO figures 117 
million people will be receiving subsidies under the Clinton-Mitchell 
bill.
  This is a massive expansion of Government, estimated to cost over 
$1.1 trillion, and people have not even looked at it. We make speeches 
that we need to balance the budget, we need to cut a couple hundred 
million dollars here and a couple million here, and talking about 
expanding entitlements $1.1 trillion over 8 years and bringing on 57 
million new people to be subsidized, including my daughter, who does 
not need a subsidy, who did not ask for a subsidy, who wants to be left 
alone so she can buy a $500 policy instead of the Government selling 
her a $2,000 policy.
  This is a ridiculous and massive raid on future generations. We 
cannot let that happen. Again, a lot of people just are not aware of 
the fact that it is in this program.
  Mr. President, I mentioned as well this bill has a lot of things in 
it for various special interest groups, and it does. It makes you 
wonder who is supporting it and why.
  One of the groups that has been very active in supporting passage of 
this bill is the abortion rights group, people who want to promote and 
encourage abortion, people who want everybody in America to have access 
to abortions. And that includes President and Mrs. Clinton. 
Unfortunately it is in the Mitchell package, and I am sure it will be 
in the Gephardt package. And I am sure in whatever package comes out of 
the conference committee, it will be in there as well.
  This bill promotes, expands, and subsidizes abortion in a way untold 
of in our country. Let me just touch on a couple ways. I will even 
refer to section numbers.
  A lot of people are not aware abortion will be covered as a part of 
every Federal benefit package. It is not today. Also, every worker will 
be required to pay for abortions with taxes and health care premiums. 
They are not today.
  Federal employees can choose whether they want to have abortion 
coverage or not. Individuals can choose whether they want to buy a plan 
that covers abortion services or not. This says no. Under the Mitchell 
bill abortion services are covered whether you want them or not.
  We might keep in mind this is supposed to be a health care bill. We 
also might keep in mind that abortion terminates the life of an unborn 
child. It kills an innocent unborn child, and this bill is saying we 
want it to be in every health care plan in America. That is serious. It 
is, whether you want it or not. There are no opt-out provisions--
whether you want it or not.
  Then it goes a little bit further and says we are going to subsidize 
it. Right now there is the Medicaid population, which is more than 
doubling under the Mitchell package. We do not subsidize abortion 
except for cases of rape and incest or in case of the mother's life in 
danger. In other words, for 99 percent of the abortions which are 
performed, we do not pay for them--we do not pay for them. We pay for 
very, very few on a Federal level, and I think that is appropriate.
  This bill says no, no, you are going to pay for it; it is going to be 
in every health care package. Taxpayers, you are going to pay for it, 
too. Under the Medicare population, hey, we are going to put it in the 
plan. This is going to be a benefit. A lot of people will use it like a 
benefit. They will use it for birth control purposes. And just as in 
D.C. where the majority of abortions are performed on people who 
already had one, two, or three abortions, you will find this being the 
case if we put in this package.
  That is really troubling, telling the people we are going to take 
taxpayers dollars to be used to pay to destroy an innocent unborn 
child. Unfortunately, it is in this package and it should not be in the 
package.
  Then the bill has another massive expansion of abortion services that 
the bill requires. On page 77, section 1128, the bill requires 
federally-guaranteed services, including abortion, to be uniformly 
available across the Nation, and readily accessible within each service 
region in each State.
  Madam President, most States do not have abortion services 
everywhere. Most States have them in big cities. They do not have them 
in rural counties. This is going to mandate those services be available 
whether people want them or not. They are going to mandate that those 
services be available. That is a massive expansion and that is a 
massive promotion of abortion.
  I think again it is a very, very serious mistake. That again is 
catering to a special interest group that has an agenda in this 
legislation, and that bothers me.
  Madam President, there are some other special interest provisions in 
this bill, one of which I almost find interesting, but I hope that 
someone will pay a little attention to. Last week the American 
Association of Retired Persons endorsed this package. We note in 
reading the bill--I hope I am reading the right bill and the right 
section because we have three different Mitchell bills. I find a very 
interesting proposal in the Medicare prescription drug benefit. Even in 
the last few days, I heard many colleagues talk about what a great 
benefit this would be for seniors. Madam President, I am not so sure 
that is the case.
  Now, we have before us a proposal to add a benefit to Medicare that 
once again many seniors already have through Medigap coverage. The bill 
does not even tell us what the bill will be. We do not know what the 
deductible will be or how it will compare to policies most seniors 
already have. Again, keep in mind 75 percent of the senior citizen 
population already have a Medigap policy. Many or most of them cover 
prescription drugs. Here is what the bill says about the deductible.

       Section 2002 (a) state the deductible amount for purposes 
     of subparagraph (a) the deductible amount is amount equal to 
     the amount determined under iii.

  That section begins on page 273. It states: For purposes of clause I 
the amount determined under the clause is (I) in 1999 the amount to be 
determined by the Secretary is such the amount determined will result 
in projected incurred spending administrative cost providing for 
payment under this for covered title outpatient I equal the intention 
target of $13.4 billion.
  In other words, sometime in 1998 the Secretary will sit down and 
figure out how high to set the deductible. The overall cost of the new 
program to offer drug programming $14.4 million.
  It means senior citizens will have to pay higher for a benefit that 
may be less generous than they now have under Medigap. Unless the 
organization understands this on the Mitchell bill--the AARP announced 
support for the bill on August 9.
  My office, and I imagine other offices, was contacted by constituents 
who say that they want to share their belief that they do not agree 
with the AARP and they do not agree with this bill.
  Mr. President, I do not know why they endorse the bill, but there is 
a very interesting provision on page 281. The provision authorizes the 
Secretary of HHS to establish a mail order pharmacy option under 
Medicare. Under this program the Secretary would solicit bids from 
various mail order pharmacies, enter into contract with one or more 
pharmacies to offer prescription drugs through the mail to 
beneficiaries.
  In paragraph 6 (a) the payment amount for covered outpatient drug 
delivery through mail order pharmacy under such contract will be equal 
to the amount bid by such plan under the subparagraph instead of the 
payment limit determined in accordance with paragraph 4.
  Paragraph 4 begins on page 277, line 13. This paragraph sets payment 
limits, price controls, for the maximum amount the Medicare will pay 
for prescription drugs, but mail order pharmacies are exempt from 
payment limits. In paragraph 4 they are exempt. So we are going to have 
price controls on drugs except for mail order pharmacies. That means 
mail order pharmacies who contract with the Secretary of HHS can charge 
Medicare more for a particular drug, than a pharmacy or other supplier.
  So we are going to have price controls on everything else except mail 
order pharmacies. Mail order pharmacies would be given special 
treatment under this bill. They will be the only supplier of 
prescription drugs that charge more than the Government-imposed price 
controls.
  What happens to a senior who ends up paying more for a drug through a 
mail order pharmacy?
  Subparagraph 6(b) says on page 281, beginning on line 20: Such 
individuals receive from the Secretary a rebate or contribute toward 
individual cost sharing amount equal to 25 percent excess of payment 
limiting to reimburse seniors who get stuck, because we did not have 
price controls on mail order, and put it on everything but not 
pharmacy.
  That is interesting. In other words, the Secretary which means, by 
the way, the taxpayer, will rebate 25 percent which the mail order 
pharmacy price exceeds the Government mandated price for the drug.
  So every dollar that the mail order charges above the Government 
payment limit, the taxpayers are out 25 cents for rebate, and the 
Medicare beneficiary is out 75 cents. The mail order pharmacy pockets 
the dollar.
  Madam President, I do not know why mail order pharmacies are made 
exempt from the stringent price controls imposed by Government in this 
legislation, nor why AARP endorsed the Clinton-Mitchell bill.
  But I do note that the AARP operates one of the largest, if not the 
largest, mail order pharmacies in the country. It also is the case that 
any mail order pharmacy that wanted to contract with the Secretary will 
be exempt from price controls that apply to all other manufacturers and 
suppliers of prescription drugs. In this instance, with the special 
treatment of labor unions in this bill, a powerful special interest is 
receiving special treatment.
  Does this go all the way back to the individuals who were putting 
this bill together in a cloud of secrecy and, quite frankly, in all 
probability illegally? Is this the reason this Times article alluded to 
the administration wanting to seek settlement of the health suit so 
people will not find out what went on behind closed doors? Is this the 
reason Ira Magaziner said all members of the staff were Government 
employees when they are were not? Is it a fact that there were actually 
people on the task force serving as staffers, putting this package 
together, working for special interest groups, maybe working for 
special interest groups like AARP, so they could exempt mail order 
pharmacies; maybe working for special interest groups like the National 
Organization of Women and other groups that are trying to promote and 
expand abortion access throughout the country; or maybe special 
interest groups like organized labor, which has certain exemptions from 
some of these actions I have alluded to?
  Madam President, I will just mention one final comment, and that is 
in the area of medical malpractice reform. In the bill that I 
introduced originally, the consumer choice bill, we had medical 
malpractice reform. Senator Chafee's bill has medical malpractice 
reform. Senator Dole's package has medical malpractice reform. The 
Clinton-Mitchell bill is a sham. It preempts State laws in 20 States, 
where they have done some good work to try curb medical malpractice. It 
preempts those.
  Basically, it does nothing that would help to get down excessive 
litigation and excessive defensive medicine; again, a serious mistake.
  I believe, again, it caters to special interest groups. The American 
trial lawyers support this legislation.
  Madam President, I think there are several fatal flaws in this bill. 
I want to repeat one, this idea when I hear somebody say this bill is 
voluntary, but yet they tell me what benefits I have to provide. When I 
see CBO says the cost of this bill is $6,000 per family, I do not think 
that is voluntary. When they tell me if I have a benefits package that 
does not quite fit this one, that I am subjected to a 35-percent tax 
surcharge, I do not think that is voluntary. When they tell me that if 
I have a high-cost plan there is a 25-percent tax surcharge that would 
push me down to have the same benefits that Government deems 
appropriate, I do not think that is voluntary. When they mandate that 
you provide abortion service when you do not want to, mandate that this 
be subsidized, and mandate they be in rural communities in North and 
South Dakota and Oklahoma, that is not voluntary.
  Madam President, there is an enormous bureaucracy, there is enormous 
taxes, over $300 billion in taxes. There is enormous new spending, $1.1 
trillion in new spending and new bureaucracies, over 50 new agencies 
and boards and commissions, some of which are worthless and some of 
which have enormous power, enormous power, where boards will be 
determining what benefits everybody in America will have, where boards 
will be determining the power of price controls, and so on. That is a 
serious mistake. That is a Government-controlled plan that we have 
before us. This is doing harm.
  And I opened my comments saying, let us do positive health care 
reform that helps the system. Let us take care of preexisting 
illnesses. Let us make sure people are not terminated from their 
insurance because they become ill, or see their insurance rates 
skyrocket. Let us put in some portability provisions. Let us put in 
some real medical malpractice reform. Let us simplify the paperwork. We 
can do a lot of things in a bipartisan fashion and we have this year, 
but this is not the solution. This is a prescription for disaster. This 
is a prescription for big Government. This is a prescription for the 
quality of health care to go tumbling down, and we should not let that 
happen.
  Madam President, I yield the floor.
  Mr. DASCHLE addressed the Chair.
  The PRESIDING OFFICER. Who yields time?
  Mr. MOYNIHAN. I yield to the distinguished Senator from South Dakota 
such time as he may desire.
  The PRESIDING OFFICER. The Senator from South Dakota is recognized 
for as much time as he will consume.
  Mr. DASCHLE. I thank the distinguished Senator from the Finance 
Committee, the manager of the bill, and I appreciate having the 
opportunity to speak again on many of the issues that we began 
addressing last week.
  I could not help but note the many references made by the 
distinguished Senator from Oklahoma to the Mitchell bill as a 
``Government plan.'' I would also note that last week a number of 
Members on both sides of the aisle expressed their concerns regarding 
the mischaracterization of either the Mitchell bill or Dole bill.
  I was interested in a comment made by our Majority Leader just 
yesterday about references made on the other side of the aisle to a 
``Government health plan.'' I find it ironic that while the Republicans 
claim they oppose Government health plans they have not introduced, as 
far as I am aware, a bill to repeal Medicare, a Government plan. I do 
not know of any Member on the other side of the aisle who has proposed 
that we repeal FEHBP, the Federal Employee Health Benefits Plan, a 
Government plan. I do not know that anyone has introduced a plan or a 
bill or a proposal at this point to repeal the Veterans Administration, 
another Government plan.
  As Members of Congress, when we visit the doctor, we go to Bethesda 
Naval Hospital or Walter Reed, both Government hospitals. When we need 
a doctor, we go to the Capitol physician, an employee of the Federal 
Government.
  So, in essence, what my colleagues on the other side of the aisle 
seem to be telling the American people, is that Government is good 
enough for us but not for you. Government is good enough for us when we 
get sick, when our families get sick, when we have an emergency, but it 
is not good enough for you.
  That would alone makes a very compelling argument about the kind of 
duplicity that occurs sometimes on the Senate floor, except for the 
fact that the Mitchell bill is not a Government plan. In fact, it is 
ironic that anyone would call it a Government plan since the 30 million 
Americans currently covered under Medicaid, a Government plan, would 
now be covered by private insurance.
  What we are saying is that there ought to be some regulatory 
framework. And if it is not Government who creates that regulatory 
framework, who does?
  Do we just turn over the entire system to the insurance industry for 
them to do whatever they wish? Do we turn it over to the doctors, the 
hospitals? How would it be if we let the airline industry run the 
entire system without any kind of oversight and regulatory control by 
the FAA. As we all know, because of this oversight the United States 
has one of the most safe--if not the safest--air control systems in the 
world today.
  How would it be if our banking system did not have a regulatory 
framework? How would it be if we simply threw the entire system of 
highways open to the private sector and let them design roads for 
whatever purposes they deemed appropriate?
  That is all we are saying, that we want that some framework, some 
standards and safeguards in our health care system. I think everyone 
recognizes the need for standards. To say that our banking system, our 
air traffic control system, our highway system is entirely run by the 
Government would be a gross exaggeration and an overstatement. The same 
is true when others characterize the Mitchell bill as a system run by 
the Government. So I hope we could properly characterize the Mitchell 
plan and recognize that we must have the kind of oversight and 
framework that we have been able to acquire in other sectors of our 
economy. I certainly hope, ultimately, when we pass the legislation 
that I know we can pass in the coming weeks, that it will recognize the 
importance of a private sector system in an appropriate governmental 
framework.
  There are a number of provisions that we all indicate are important 
to us. We have heard speeches on both sides of the aisle about the 
importance of uniform coverage. We have heard statements about the 
importance of effective cost control. We have heard many statements 
from Members of both sides of the aisle that if indeed we do anything, 
we have to ensure that there be market reforms.
  Finally I think I have heard Members on both sides of the aisle 
repeat with some frequency how important it is that we give the 
American people the same opportunities for coverage that we have in 
Congress. Those are statements made, I think, with similar frequency on 
both sides of the aisle. But when you really begin to compare what is 
offered by the Republican leader and what is offered by the majority 
leader, you begin to see there is a difference between rhetoric and 
fact, between statements of intent and the actual creation of a 
mechanism to accomplish what we say we all want.
  So I would like to spend a little time this morning talking about the 
way both bills address those things that we feel are critical to 
meaningful health reform. When I say ``we,'' I am talking about Members 
on both sides of the aisle, Republicans and Democrats, who acknowledge 
the importance of universal coverage, effective cost containment, who 
acknowledge the importance of meaningful insurance reforms, and access 
to a health system that we as Members of Congress take for granted.
  Universal coverage, I think, is an important beginning. Universal 
coverage has certainly been the subject of a great deal of analysis and 
discussion and consideration for many years. The Clinton administration 
made universal coverage its No. 1 goal. Senator Mitchell, the majority 
leader, has indicated that his bill would put us on the road to 
universal coverage by a date certain, reaching at least 95 percent 
coverage by the year 2000.
  The Dole bill, as I indicated last week, is just beginning to be 
better understood. We have not had a chance to look at all of its 
provisions in great detail and subject it to the analysis of CBO, which 
will be performed at some point.
  But we do know this: We do know that the Dole plan leaves millions of 
Americans uninsured. On that fundamental goal that we deem so critical, 
according to a Lewin-VHI analysis, the Dole proposal leaves out three 
out of four uninsured Americans by the year 2000. So, 75 percent of 
those who are uninsured today will be uninsured under the Dole bill in 
the year 2000--6 years from now. More than 6 million children will 
still be uninsured under the Dole bill at the end of the decade. 
Congress is not even required to consider recommendations for achieving 
the goal of universal coverage.
  Madam President, if we enacted the Dole bill today, 30 million 
Americans would still not have health insurance 6 years from now. That 
is one of the biggest differences between the Dole bill and the 
Mitchell bill. Not only are we reversing the downward trend of insured 
Americans today under the Mitchell bill, going from 85 percent to 83 
percent just in the last 2 years--the Mitchell bill would reverse that 
trend. According to the Congressional Budget Office, health insurance 
coverage would jump from 83 percent in 1994 to at least 95 percent by 
the year 2000. Attaining universal coverage, our most fundamental goal, 
is one of the real differences between the Dole and the Mitchell bills.
  So what is the implication to that? It is not just an egalitarian 
motive. It is not just important we provide coverage to everybody 
simply because it is the right thing to do. What expert after expert 
has reported to the Congress, what Lewin-VHI has indicated in their 
reports to the Congress, is that if we fail to achieve universal 
coverage, the extraordinary problem of cost shifting will continue. An 
individual who is uninsured today will is most likely to get care in 
most expensive setting possible, in an emergency room. Despite their 
lack of insurance, the hospital will still provide care to them. 
However, the hospital will shift these uncompensated costs onto others. 
These uncompensated care costs will be shifted onto the insurance 
companies, shifted onto individuals, shifted onto businesses, shifted 
onto the Government. Everybody but that individual receiving the 
services will be required to pay something for the costs associated 
with uncompensated care provided in the emergency room or any other 
setting. This cost shifting has increased premiums by as much as 30 
percent. Under the Dole bill, since it does not achieve universal 
coverage, cost shifting will continue.
  So we have a very fundamental difference of opinion with regard to 
what ought to be the ultimate goal of meaningful health reform. The 
Mitchell bill, quite simply, says let us achieve 95 percent coverage in 
the next 6 years. And let us get onto the road to universal coverage 
sometime shortly after that. And let us end the very serious problem of 
cost shifting by achieving universal coverage.
  The Dole bill says that achieving universal coverage is something we 
just cannot do. The best we can do is try to insure one out of every 
four Americans over the next 6 years, leaving three out of those four 
who are uninsured, still uninsured even in the year 2000.
  So I think that is something everyone ought to fully appreciate as we 
are beginning to analyze how we compare and contrast the Dole and 
Mitchell bills in the coming days.
  The second issue has to do with cost containment. If there is another 
very critical point upon which there is vast agreement in the speeches 
on either side of the aisle, it is that we must have effective cost 
containment. It is no secret that costs have skyrocketed over the last 
several years. We are now at 14 percent of GDP. CBO says if we do 
nothing we could reach 20 percent of GDP in the next 6 years. So 
clearly cost containment is something that we all recognize is critical 
to meaningful health reform.
  Universal coverage is essential to cost control. You cannot really 
have one without the other. You cannot have meaningful cost containment 
if you leave a lot of people uninsured and out of the system because, 
again, cost shifting is going to drive up costs, both administrative 
and direct costs.
  There is no cost containment anywhere to be found in the Dole bill as 
it is currently written. And for that reason alone, I think you could 
call the Dole bill the Insurance Industry Protection Act. Furthermore, 
the market reforms in Senator Dole's bill are riddled with loopholes 
and fine print and will not encourage competition on price and quality.
  Many people have indicated the Mitchell bill is 1,400 pages; the Dole 
is about 700 pages. I think I happen to have both of them right here 
with me. It is half as thick because it does half as much. It does 
little, if anything, on universal coverage, and it does virtually 
nothing when it comes to cost containment. Cost shifting, as I 
indicated, has cost businesses more than $40 billion more per year than 
they ought to be paying--that $40 billion could be going into higher 
salaries, more profits, greater dividends for shareholders--$40 billion 
that makes us completely uncompetitive when it comes to our 
international competition.
  There needs to be a recognition that cost-shifting costs the 
individual family 15 to 20 percent more in higher premiums to cover the 
uninsured. So without any doubt, employers are paying the price today 
for those without coverage. The free-rider competitors that are not 
required to contribute to health insurance are the ones shifting the 
costs of their employees coverage onto businesses that do not provide 
insurance.
  If we do not have meaningful cost containment, if we do not have a 
way to ensure that businesses can control their health costs, then I 
have to tell you, Madam President, I think we will have failed as a 
country--we certainly will have failed in the U.S. Senate--to respond 
to those businesses who have made it very clear to us, that, while they 
want universal coverage, they also need more confidence they can 
control their future health care costs.
  A family in 1998 making between $30,000 and $40,000 would pay $713 
more in a nonuniversial system than with universal coverage, according 
to Lewin VHI.
  So businesses and families beware, if we pass health insurance reform 
without effective cost containment, costs will continue to rise. That, 
Madam President, will be a tragedy not only for those families and 
businesses, but for the economy, for competitiveness, and for health 
security.
  We should recognize that the Dole bill is substantially different 
when it comes to cost containment than the Mitchell bill. Time after 
time, we have heard on the other side of the aisle how the Mitchell 
bill fails to achieve the goals the Clinton administration has set out. 
Let me tell you, there is no comparison between the Dole bill and the 
Mitchell bill when it comes to cost containment. In the Dole bill, 
there simply is no cost containment. Everyone should recognize this as 
we deal with this issue over the next several days.
  The third issue that we have discussed at some length has to do with 
insurance market reforms, and the fact that if, indeed, we are going to 
build upon the current system, we must recognize some of the 
inadequacies of the current system. Many insurance reforms have been 
proposed over the years.
  But the Dole Insurance Industry Protection Act, leaves out many of 
these reforms. The Senator from Oklahoma earlier had made a point about 
the fact that both Dole and Mitchell eliminate preexisting condition 
exclusions. In fact, the Dole bill does not eliminate preexisting 
condition exclusions. They are still allowed.
  Anyone who has had the chance to read the bill carefully will be 
concerned about the coverage that one is allowed to acquire if they 
lose their job, if they move to another State, if there is a change in 
their personal circumstances. There is no guarantee of portability, 
Madam President, in the Dole bill.
  Third, the Dole bill contains, in effect, a 15-percent premium tax. 
It allows insurance companies to charge up to 15 percent in 
administrative cost to anybody who is in the community-rated pool; 15 
percent over and above the standard premium.
  Fourth, access to an FEHBP plan--something we say ought to be 
available to all Americans--is limited.
  And fifth, there is absolutely no guarantee of choice. In fact, under 
the Dole plan, you may not even have a fee-for-service plan available 
to you.
  I want to talk briefly about all five of those points, if I can, 
because I think they are very noteworthy and, again, a significant 
departure from what the Mitchell bill attempts to do.

  As I said at the beginning of my discussion with regard to market 
reform, perhaps the only issue about which there is no disagreement, 
that we ought to do as much as we can to eliminate preexisting 
condition exclusions. The preexisting condition exclusion, precludes 
someone with any medical condition or disability from obtaining 
coverage for that condition--if they have heart disease, if they have 
cancer, if they have diabetes, if they have any one of a number of 
diseases today, often they cannot get insurance.
  If they acquire those diseases after they have insurance, chances are 
at some point in the process, they will be dropped. As was indicated, 
there probably are differences with regard to how we would interpret 
preexisting conditions, but there is no difference at all in the stated 
determination on both sides of the aisle to eliminate preexisting 
condition exclusions. And yet if you look at the Dole bill, in spite of 
its stated intentions, coverage can be denied up to 12 months for 
individuals with preexisting conditions and 6 months for those 
purchasing coverage in a group. While the Mitchell bill phases out 
preexisting conditions entirely with universal coverage, during the 
transition period, the exclusion is only for 6 months.
  Let me try to contrast the Mitchell and the Dole bills on this point.
  Under the Mitchell bill, there is a 6-month exclusion allowed 
initially but it is phased out entirely over a 6-year period of time. 
Under the Dole bill, a 12-month exclusion is allowed for an indefinite 
period of time. So 10, 15, or 20 years from now, if you have a 
preexisting condition, you may be excluded from your insurance 
company's policy for whatever preexisting condition you may have.
  What kind of coverage is that? What kind of protection, what kind of 
security, what kind of guarantee are we providing the American people 
if after 10 years, a preexisting condition can still preclude you from 
getting the kind of care that you ought to have?
  Clearly, there is a significant difference between the Mitchell and 
the Dole bills when it comes to insurance market reforms, specifically 
regarding preexisting conditions.
  The Dole bill also contains exceptions to portability. Senator Dole's 
bill allows insurance plans to enroll individuals and firms on a first-
come-first-served basis. Insurance companies and their agents can, 
therefore, control who they will insure. They may want to insure only a 
white collar group in the middle of a city. They may not be interested 
in insuring farmers or an agricultural co-op in South Dakota. Under the 
Dole bill, they will have that right to preselect, to enroll people 
that they might prefer to have in their plan, leaving vulnerable those 
who cannot enroll.
  Madam President, the Mitchell bill does something entirely different 
in this regard. It guarantees everyone an equal opportunity to enroll 
in the plan of their choice, regardless of what point during the open 
enrollment period they sign up for coverage. The insurance plan must 
take everybody up to its capacity. If you want to enroll in Blue Cross/
Blue Shield, that is your right. If you want to enroll in some other 
plan, that is your right.
  So we talk a lot about the importance of having choice of plans and 
providers, but there is a substantial difference between what the 
Mitchell bill will do with regard to the opportunity for individuals to 
enroll in the plan of their choice and what the Dole bill does in this 
regard.
  I mentioned another aspect of market reform, Madam President, the 
fact that the Dole bill includes a 15-percent insurance company premium 
tax. The Senator from Oklahoma talked a good deal about taxes in the 
Mitchell bill. I wish I had time to go through a clarification of many 
of those taxes he pointed to.
  The Mitchell bill does say there will be a 25-percent tax, only on 
those plans whose premium increases exceed a target rate. That is, if a 
plan exceeds the CPI plus a certain percentage, there is an automatic 
mechanism to contain those costs in the future by levying an assessment 
on those plans. There is nothing like that in the Dole bill. If an 
insurance company wants to charge policy holders 15 or 20 percent in 
additional premiums, that is their right. There is nothing in the Dole 
bill to control insurance company premiums. There is no commitment to 
restrain growth in a given year.
  The Dole plan says, ``Go ahead, insurance companies, continue to 
increase your premiums at 15 or 20 percent; we're not going to stop 
you.''
  But we are going to let you charge 15 percent above your base premium 
for community-rated plans--we will allow a 15-percent administrative 
charge to be tacked on to all insurance plans.
  Mr. WALLOP. Will the Senator yield for a question?
  Mr. DASCHLE. I will be happy to yield at the end of my statement. I 
note that the Senator from Oklahoma preferred to continue with his 
statement, so I will do that, and I would be happy to open it up to the 
distinguished Senator from Wyoming if he so chooses afterward.
  The fourth point that I make, Madam President, has to do with access 
to FEHBP, the Federal Employee Health Benefits Plan. The Dole bill does 
not provide everyone access to FEHBP, in spite of the fact we all have 
indicated that that is something we ought to provide. We talk about the 
importance of giving the American people the same coverage we have, and 
I think that is a fundamental difference, between what the Republicans 
have proposed and what we are proposing.
  Under the Dole plan, the only people that would be allowed access to 
the FEHBP are those who are working for an employer who chooses an FEHB 
Plan. But there is a further constraint in order to be eligible for 
FEHBP. You must work for an employer with fewer than 50 workers. If you 
work for any employer with more than 51 workers, you are out of luck.
  In spite of all the recognition of the importance of having access to 
the Federal Employee Health Benefits Plan, under the Dole bill any 
employer with more than 51 people is automatically excluded from FEHBP. 
And that is not the only constraint. Outside enrollment is limited to 5 
percent of the health plan's overall FEHBP enrollment. If the Dole bill 
were to pass, FEHBP would be available only to 5 percent more 
individuals.
  On top of that, the Dole bill suggests that people who are not 
Members of Congress or employees of the Federal Government would pay a 
15-percent surcharge for enrollment in FEHBP. Apparently what we are 
saying is it is OK for us to have discounted premiums, but if you are 
going to enroll in the same plans that Members of Congress have, you 
may have to pay 15 percent more. You can be a worker with a limited 
income, working for a small businessman who for the first time may be 
offering insurance. You can have the same access to the plan we have if 
your employer chooses to give you access to an FEHB Plan, but if you go 
through all these hoops and hurdles, you still have to pay 15 percent 
more than what Members of Congress pay for the same coverage. That is 
the Dole provision on FEHBP.
  Finally, under market reform, Madam President, let me touch on 
another matter that I think is very important. We have heard a lot of 
discussion about choice--choice of doctor and choice of health plan. 
Under the Dole bill, cooperatives and employers are not required to 
offer a choice of plans or a choice of doctor. They may offer their 
employees plans that do not include a fee-for-service plan. Employers 
do not have to make available a fee-for-service plan. You can offer 
anything you want. So if your employer decides to go for the least-cost 
plan, he may sign you up with an HMO, a PPO, or a plan with very 
limited options, and if you are the employee, you have to take that 
policy, or you do not take anything at all.
  Where is the choice? We talk a lot about choice just as we talk a lot 
about universal coverage and cost containment and market reform. But 
where is the choice if an employer today can deny you the same choices 
that the Mitchell bill, the Clinton original bill, and all of those 
plans have said is so critical to meaningful health reform? Where is 
the choice when an employer can cut you out of a fee-for-service plan, 
and can restrict your choice of doctor? There is no choice, and that is 
something I hope will be well understood as we compare and contrast the 
Mitchell and the Dole bills.

  The next point that I think has been made in the past but is worth 
repeating is the importance of cost when it comes to the working 
families.
  I have a chart that outlines the average cost of a plan in terms of 
percent of income under the Mitchell bill. Under the Mitchell bill, if 
you have an income of $22,172--that is about 150 percent of poverty--
your payment would be $1,471, which is about 6.6 percent of family 
income. Under the Dole plan, the average premium would be $5,883, or 
26.5 percent of family income. That is the difference, Madam President. 
A working family of four with a reasonable income of $22,000 will pay 6 
percent of their income under the Mitchell plan, and 26 percent under 
the Dole plan.
  If you look at the impact on children, the situation is even more 
stark. Under the Mitchell bill, that same family with a $22,000 income, 
at 150 percent of poverty, would pay no premium to cover two children. 
Under the Dole plan, a family with children would pay 26.5 percent of 
their income in premiums.
  As we go through these calculations, it becomes clear the Dole plan 
is an expensive plan. The Dole plan not only does not cover everybody, 
but costs will be very high for those it does cover.
  Madam President, a question was raised today about why seniors would 
support the Mitchell bill and not the Dole bill.
  I think it is pretty obvious why the Mitchell bill enjoys the support 
of seniors across the country. The Mitchell bill is endorsed by AARP 
and many individual seniors because it does something for seniors. It 
recognizes the importance of prescription drug coverage for seniors. It 
recognizes that more than 18 million Americans over the age of 65 would 
obtain drug coverage under the Mitchell bill, but would have no 
coverage under the Dole bill.
  The Dole bill does not ensure drug coverage for seniors. It leaves 
seniors completely out in the cold.
  It is not just seniors who are left out. I mentioned earlier the fact 
that businesses are going to absorb $30 billion this year to cover the 
uninsured. We are told by Lewin-VHI, if we do nothing or if we pass the 
Dole bill, the cost shift on American business today would go from $30 
billion to $45 billion by 1998.
  That is a substantial increase in the cost that businesses are going 
to have to absorb simply because there are currently free riders in the 
system today. Family coverage will still be one-third more expensive in 
1998 than it is right now to pay for these free riders. Under the Dole 
bill, there are no employer discounts, no incentives to provide 
coverage, no guarantee that we are going to end the cost shifting. 
Businesses, small and large, are going to continue to absorb the costs 
that they are absorbing today. They are just going to absorb a whole 
lot more.

  Finally, let me touch on an issue that is very important to the 
manager of the bill, the chairman of the Finance Committee. We have 
talked at length about research and work force training. These topics 
are important not only to the State of New York but to every State. 
Science is important. Medical research is perhaps the key to our long-
term future. We must continue to send the message, not only to those in 
our country but around the world, that we are going to invest in 
technological innovation and medical research in a way that gives us 
the ability to respond to the medical problems that we have in the 
country today.
  Under the Dole bill, there is no additional Federal money for 
research or work force training. Under the Dole bill, the only 
additional NIH research funding would be funded through a voluntary $1 
tax return add-on. This is another reason why the Dole bill is slimmer 
than the Mitchell bill. The Dole bill leaves out research.
  (Mr. BYRD assumed the chair.)
  Mr. DASCHLE. Under the Dole bill, public support for academic health 
centers is reduced without any increase in coverage or funding to 
offset the loss from the reduced ability to cover costs from the 
private sector.
  Mr. President, I hope that as we go through the coming days we will 
have the opportunity to compare the Dole and Mitchell bills, and that 
we will have the opportunity to prove that the Mitchell bill is a 
thicker bill because it simply does more. In fact, I believe it does 
more than twice what the Dole bill does. I hope that throughout the day 
today we will have opportunities to revisit many of these issues again.
  I yield the floor.
  Mr. WALLOP addressed the Chair.
  The PRESIDENT pro tempore. The Senator from Wyoming.
  Mr. WALLOP. Mr. President, I am about to yield to the Senator from 
Texas 3 minutes. But let me say to my friend that I do not know why 
anybody is talking about the Dole bill a lot of us have cosponsored. It 
has more cosponsors than any other bill around. But the fact of it is 
that we are not to be allowed to debate it or discuss it because we are 
not to be allowed to have CBO's estimate on it. We are not to be 
allowed because it is taking place behind the House's need for CBO's 
estimate. We have the CBO estimate on the Clinton-Mitchell bill. But we 
are not to be allowed. So whatever you say about the Dole bill may or 
may not be true. I suggest that I quarrel with most of what the Senator 
said. But the fact of it is, it is irrelevant because we are not to 
allowed to have that as a part of the debate.
  The PRESIDENT pro tempore. The Senator from Texas [Mr. Gramm] is 
recognized for 3 minutes.
  Mr. GRAMM. Mr. President, in listening to our colleague from South 
Dakota, I am stunned that anybody could be against the Mitchell bill 
and be for the Dole bill. Listen to what our colleague said. He said if 
you are making $22,000 a year, under the Dole bill you will have to pay 
26 percent of your insurance premiums. Somebody else is going to pay 
the rest of it. Under the Mitchell bill, you are only going to pay 6 
percent, and somebody else is going to pay the other 94 percent.
  Our dear colleague from South Dakota said that under the Mitchell 
bill, we are going to give $96 billion of new benefits to our senior 
citizens. How could anybody listening to those wonderful numbers be for 
the Dole approach and not be for the Mitchell approach? There is only 
one reason, and the reason is that the Mitchell bill cost $1.1 trillion 
over a 10-year period.
  In 1950, the average American family with two children sent $1 out of 
every $50 it earned to Washington, DC. Today, that same family sends $1 
out of every $4 it earns to Washington, DC, and under the Mitchell 
bill, in 10 years that family would send $1 out of every $3 it earns to 
Washington, DC.
  So there is only one reason that someone would not think it is such a 
great and wonderful idea for the Government to give all of these 
benefits away. And the reason is the Government is broke. The reason is 
that when somebody gets something for nothing from the Federal 
Government, some working person somewhere gets nothing for something. 
Who is paying for all of these great subsidies? Who is picking up cost 
of the other 94 percent of the cost of health insurance under the 
Mitchell bill? The taxpayer. Who is picking up the tab for all of these 
new and wonderful benefits that we all wish the Lord had simply 
provided? They probably were provided in the Garden of Eden. But having 
arrived in the state we are currently in, ultimately the only way we 
can give things away is to take them from other people.
  There are literally tens of millions of Americans who believe that we 
have already taken away too much from the people who do the work, pay 
the taxes, and pull the wagon in America and that this process has to 
stop.
  The big difference between the Dole bill and the Mitchell bill is 
that the Dole bill seeks to reform health care by promoting a more 
efficient system. The Dole bill will help working people by paying part 
of their premiums, not as much as the Mitchell bill--but without the 18 
new taxes found in the Mitchell bill. The Mitchell bill has 40 new 
Government regulatory agencies, and over 100 unfunded mandates.
  It is a miracle what you can do with $1.1 trillion, which is what the 
Mitchell bill would spend in a decade. There are only two problems, 
however. No. 1, it is not our money. No. 2, the only way we can get the 
money is by reaching into the pockets of the working men and women of 
America and taking it away.
  So if all you want is more Government, then you are for the Mitchell 
bill because it gives you more Government, and it gives you more 
Government in a greater abundance than any other bill ever considered 
in the history of the United States of America.
  The problem is that the American people do not want all of this 
Government. That is why the Mitchell bill is losing, why the Gephardt 
bill is losing, and why the Clinton bill has lost. The sooner we stop 
talking about all of the free things that are given away and start 
talking about how we are going to pay for them, the sooner we might 
actually be able to write a bill that would meet the needs, not just of 
all the people riding in the wagon, but meet the needs of the people 
pulling the wagon.
  I yield the floor.
  Mr. PACKWOOD addressed the Chair.
  The PRESIDENT pro tempore. The Senator from Oregon, [Mr. Packwood].
  Mr. PACKWOOD. Mr. President, I believe the Senator from South Dakota 
has a statement. Are we under controlled time?
  The PRESIDENT pro tempore. We are not under controlled time. The time 
is equally divided.
  Mr. REID. Parliamentary inquiry, Mr. President.
  The PRESIDENT pro tempore. The Senator does not have the floor.
  Mr. PACKWOOD. I yield such time as the Senator from South Dakota may 
need.
  The PRESIDENT pro tempore. Does the Senator from Oregon yield for a 
parliamentary inquiry to the Senator from Nevada?
  Mr. PACKWOOD. Yes.
  Mr. REID. Parliamentary inquiry, Mr. President.
  The PRESIDENT pro tempore. The Senator will state the parliamentary 
inquiry.
  Mr. REID. I was told by the manager of the bill on this side that we 
would go side to side, and that I would have time during today. That 
being the case, the Senator from Texas just completed his statement.
  The PRESIDENT pro tempore. The Chair is not aware of any such 
provision in the unanimous-consent agreement.
  Mr. PACKWOOD. I wonder if I might solve it in this fashion. I 
apologize to the Senator from Nevada. Senator Gramm indicated that he 
wanted to respond to a point raised by Senator Daschle. When we were 
debating this last week, we went to one side and then to the other. I 
would appreciate it because the Senator from South Dakota has been 
waiting and was scheduled to go--his statement is not a long 
statement--if he could do it. Senator Gramm says he spoke 2 minutes 20 
seconds.
  So I would very much appreciate it if the Senator from Nevada would 
indulge us. I apologize if that agreement was made. But Senator 
Pressler was from our standpoint scheduled to go next.
  Mr. MOYNIHAN. Mr. President, I am sure we can work this out. Senator 
Gramm's intervention was in the way of a response to a specific point 
that had been made by the previous speaker. I had fully expected that 
there would be a proper address on this side, and at the conclusion of 
which the Senator from Nevada will have as much time as he would like.
  Mr. PACKWOOD. I thank the chairman. I thank very much the Senator 
from Nevada. I yield such time as the Senator from South Dakota may 
need.
  The PRESIDENT pro tempore. It is the Chair's understanding now that 
no order has been entered for alternate recognition.
  Mr. MOYNIHAN. Mr. President, I do not know that this would be 
necessary. I believe that as the respective managers we have worked 
this out on the basis of comity. It may be that a time will come when 
no speaker appears on one side and the attendance is not excessive, as 
is evidenced by the graciousness of the President pro tempore to 
preside. We do not request that.
  The PRESIDENT pro tempore. The Chair understands. The Chair will have 
to make it clear that the Chair will accord recognition on the basis of 
the rules, unless an order is entered that there be alternate 
recognition.
  The Senator from South Dakota is recognized.
  Mr. PRESSLER. Mr. President, let me begin by saying that I welcome 
the debate which will occur over the next few weeks. It will be a 
spirited debate, and it will force us to take a stand on difficult 
issues. It also will require us to stop the rhetoric and begin voting. 
As we debate, we must not overlook one simple fact: Health care reform 
will literally affect every man, woman, and child in this country. We 
need to proceed with extreme caution. Our decisions will impact all of 
our constituents.
  We all agree that our health care and health insurance systems need 
some reforming. Our differences are not about whether we need reform. 
Rather, this debate is about how best to reform those systems. The 
health care debate really boils down to one simple question: How much 
Federal Government do we want in our health care system?
  Medicine is defined as the study, treatment, and prevention of 
disease. Our medical system is one of the best in the world. In 1920, 
the average life expectancy of an American was 54 years. Today, that 
has climbed to 75. In 1920, the 10 most serious diseases were 
tuberculosis, influenza, pneumonia, nephritis, sclerosis, cephalitis, 
diphtheria, whooping cough, measles, and gastritis.
  Today, vaccines and medications have greatly reduced the occurrence 
of these disorders. Over one-half of all medical technology--the life-
saving machines, treatments, and medications that make our system 
great--have been developed in the United States. Over 90 percent of our 
medical technology is developed in the private sector.
  Despite its flaws, our medical system is the best in the world. It 
does work. Our system has enabled us to live longer and more productive 
lives. Change for change's sake must not be permitted to jeopardize 
this achievement.
  The primary focus of the health care debate has been on those 
Americans who do not have health insurance. We need to help them. This 
can best be done, in my judgment, through insurance reforms and 
subsidies. However, the health care debate has failed to focus on those 
Americans who do have health insurance. An estimated 85 percent of 
Americans have health insurance. We cannot forget them in this debate. 
We must not jeopardize the health care of these individuals.
  A poll conducted by a newspaper in my State indicated that 80 percent 
of all South Dakotans were satisfied with their health insurance. Poll 
after poll confirms that most Americans are satisfied with their health 
insurance. Consequently, I ask, why do some advocate a radical overhaul 
of the entire health care system?
  Do Americans desire to pay less for their health care? Of course. Can 
steps be taken which will reduce medical costs? Of course.
  Do Americans want some changes? Yes, they do. However, they do not 
want reform just for the sake of reform.
  Mr. President, my point is this: We need to listen to all Americans. 
They are telling us to proceed with caution and to fix only the broken 
elements of the system. South Dakotans are letting me know how they 
feel. My office has been receiving over 100 calls and letters each day 
on this issue. Between the time the President introduced his health 
plan last fall and April 1 of this year, over 19,000 South Dakotans 
contacted me to express opposition to all or part of President 
Clinton's health plan. The message is clear--South Dakotans do not want 
a Government-controlled health care system.
  I normally do not find myself quoting newspaper editorials. However, 
several papers in my home State have printed editorials that reflect 
the sentiments of South Dakotans. The Mitchell Daily Republic gives 
this advice:

       There's no question that changes in health care are needed. 
     But to change for change's sake would be folly.
       Our advice: Slow down. Depoliticize. Do it right the first 
     time.

  The Yankton Press and Dakotan writes:

       Bulling through ``something'' that will get a majority vote 
     in Congress may be good politics, but it's bad policy.

  The Watertown Public Opinion writes:

       Gephardt, Gibbons, and others who favor employer mandates 
     apparently feel the tremendous job losses and reductions in 
     wages are not too high a price to pay for health reform. We 
     suspect most working Americans feel differently * * *.

  The Huron Plainsman writes:

       There are alternatives on the table that could do some good 
     without starting from scratch--for example, portability of 
     health insurance from job to job, insurance pools for 
     preexisting conditions, and those struck by catastrophic 
     illness * * *.

  Mr. President, these articles reflect the views of my constituents.
  I ask unanimous consent to insert the full newspaper editorials I 
have referred to in the Record.
  There being no objection, the articles were ordered to be printed in 
the Record, as follows:

                [From the Daily Republic, Aug. 10, 1994]

                    Bad Health Bill Worse Than None

       It was one of those sound bites television is known for, 
     which means it's done in a flash, so we apologize for not 
     attributing it.
       But in essence, the voice was saying, ``Passing a bad 
     health care bill would be worse then passing no bill at 
     all.''
       We couldn't agree more.
       Why are some so eager to rush to judgment on health care? 
     In a word, politics.
       There is a theory making the rounds that if President 
     Clinton and the Democrat controlled House and Senate can pass 
     a health bill soon, it will help them during the November 
     elections.
       It's no secret that Republicans believe they can make 
     inroads in the Democrat majorities in both houses. Maybe they 
     will. If so, it would not be unusual in an off year election.
       But political strategies should be left out of a reform 
     measure that promises to be the most far-reaching legislation 
     since Medicare. The key question should be if a hastily 
     pasted-together health care bill would be good for the 
     public. That's an easy one to answer.
       Just the sheer complexities of the proposals are enough to 
     boggle the experts, let alone Congress. And, the differing 
     characteristics of each plan has splintered the support. For 
     instance, the bill proposed by Senate Majority Leader George 
     Mitchell last week, which was a far cry from Clinton's 
     original bill, still has so many negatives that it has failed 
     to attract the needed bipartisan support.
       The bill proposed by House Majority Leader Richard Gephardt 
     faces a similar fate. And for good reason. The mandates 
     forced on businesses in the Gephardt proposal could cost 
     thousands of jobs because it forces businesses with more than 
     100 employees to pay 80 percent of their employees' health 
     insurance.
       That aspect alone would run up $58.8 billion in new costs, 
     or about $586 for each employee, according to some analyses.
       What is deeply troubling is the mindset that ``some'' sort 
     of health care plan must be passed this summer or fall. Never 
     mind that no firm dollar figures have been attached to any of 
     the administration's proposals; never mind that an increasing 
     number of Americans are seeing that a blank check for a new 
     federally administered program would be disastrous.
       Thre's no question that changes in health care are needed. 
     But to change for change's sake would be folly.
       Our advice: Slow down. Depoliticize. Do it right the first 
     time. It will be less costly in dollar and human terms and 
     the end product will be of far better quality.
                                  ____


  Any Federal Health Care Plan Deserves More Time for In-Depth Studies

       Whether Sen. Larry Pressler has the best ideas on health 
     care plans or the worst, the South Dakota Republican's 
     comment recently to reporters on the subject is worth 
     analysis.
       Says Pressler, Democrats will try to blame Republicans for 
     blocking health care reform efforts, but it's the Democrats 
     themselves who can't get together on a single plan.
       While an analysis by an opposing politician usually is 
     poopooed, this one makes pretty good sense.
       So also does Pressler's comment that, ``This is a very 
     important bill to South Dakota and the nation. I think we 
     should have time to study it, at least.''
       Pressler is at least 100 percent right on that.
       Whether the reader is absolutely convinced that the country 
     really needs fully socialized medicine, or whether the 
     preference is for no public involvement at any level, 
     Pressler still is right.
       There has been, and will continue to be, too much hype on 
     health care.
       The major problems have likely been ignored, anyway.
       Assuming that ``the wheels'' are right in their figures 
     that only about 20 percent of Americans aren't covered, and 
     that surveys show that health care is not even a top issue 
     for most of us, one wonders what is driving the health care 
     legislation engine.
       It might be that the worst problems are in urban areas 
     where there is the most representation.
       It might also be that hospitals and doctors are tired of 
     messing with ``charity'' patients whose medical bills then 
     must be paid for from inflating the bills of paying customers 
     who have insurance of one sort or another.
       It might also be that there are some folks who genuinely 
     believe that socialized medicine, Soviet style, is the only 
     fair way to offer treatment to Americans.
       And don't forget the possibility that there are some folks 
     who are looking at the trends, and figure that there is no 
     way on earth for the country to pay for the highest level of 
     medicine when the baby boom hits retirement age.
       There are all kinds of disagreements on policy and 
     philosophy to be found in any bill. The situation with 
     various cost-inflation factors--$10 sneeze-tissue boxes, for 
     example--is enough to make the most dedicated right-winger 
     cringe and suggest federal regulation.
       Also for example, those who sincerely object to abortion or 
     blood transfusions should have their rights upheld along with 
     those who fervently disagree. That won't be easy.
       Anyone studying the question also agrees that, morally 
     distasteful as it may be, there likely will be quotas on 
     treatment and spending that will result in deaths when more 
     treatment might have some slight chance of success.
       As this column has said before, there are many deep 
     philosophical questions on medical ethics that the country 
     must generally agree to. Otherwise, no ``federal health care 
     program'' can succeed.
       That's why Pressler is right in suggesting more time to 
     study any bill: Bulling through ``something'' that will get a 
     majority vote in Congress may be good politics, but it's bad 
     policy.
       Bad, politically correct law is still bad law.
                                  ____


              Health Care Mandates Appear To Be Unhealthy

       House majority leader Richard Gephardt, D-Mo., is putting 
     the last touches on a health reform bill that he expects to 
     bring to the floor for a vote in the near future. Like so 
     many issues coming out of Washington, the more we read about 
     them the more confusing they become.
       However, this much we know about the forthcoming bill: It 
     is a derivative of a measure previously approved by the 
     taxwriting House Ways and Means Committee. It would finance 
     universal coverage of all Americans, primarily by imposing 
     employer mandates.
       Like President Clinton's original proposal, Gephardt's bill 
     would require that employers pay 80 percent of workers' 
     health insurance premiums. At the moment, it appears unlikely 
     that a majority of the House will support such a crushing 
     mandate.
       Even House Speaker Thomas Foley, D-Wash., has backed away 
     from full-blown support for the most controversial element of 
     the Clinton plan. Recently, he floated the idea of setting 
     the employer mandate at 50 percent with workers picking up 
     the remainder.
       But it matters not politically, whether the employer 
     mandate is set at 80 percent or 50 percent. If liberal 
     leaders want to pass a health reform bill this year, if they 
     hope to win any support from conservatives, they must 
     jettison the employer mandate altogether.
       Of course, many of the liberal lawmakers continue to insist 
     that employers be forced to pay much of the cost of health 
     reform. The acting chairman of the Ways and Means Committee, 
     Rep. Sam Gibbons, D-Fla., warns that even reducing the 
     employer mandate from 80 percent to 50 percent would require 
     the government to spend an additional $30 billion a year on 
     health care subsidies.
       The problem with Gibbons and other advocates of employer 
     mandates is that they have too little appreciation for the 
     dynamics of the American economy. They think they can hit 
     employers with a mandate--essentially an indirect tax, 
     costing upward of $100 billion a year--and that those 
     employers will continue to conduct business as usual.
       Of course they won't. If employers are forced to pay an 
     expensive new mandate, they will have to cut costs. The 
     likeliest way of doing that is by lowering the overall wages 
     of their workers or paring altogether from their payrolls 
     those whose productivity does not cover their salary plus the 
     additional cost of their health benefits.
       Harvard professor Martin Feldstein, who also presides over 
     the National Bureau of Economic Research, estimates the 
     employer mandate would result in a 6.4 percent reduction in 
     average wages by 1997. That's a $115 billion net loss in 
     worker income. This, in turn, would lead to a loss of $49 
     billion in tax revenue in 1997 alone, he reports.
       Meanwhile, an analysis by the consulting firm of DRI/McGraw 
     Hill estimates job losses stemming from the employer mandate 
     at anywhere from 888,000 to 2.4 million.
       Even the Clinton administration has conceded the mandate 
     would eliminate at least 600,000 jobs.
       Gephardt, Gibbons and others who favor employer mandates 
     apparently feel the tremendous job losses and reductions in 
     wages are not too high a price to pay for health reform. We 
     suspect most working Americans feel differently. . .
                                  ____


                   [From the Plainsman, Aug. 9, 1994]

                Health-Care Bill Comes Down to the Wire

       Eleven months after President Clinton unveiled his health-
     care reform package to Congress and the nation, the issue he 
     has called the cornerstone of his presidency has all but 
     crumbled.
       The reason: The White House and Democrats have seriously 
     misjudged the public's vital signs, while Republicans have 
     forced the debate into a referendum on whether citizens want 
     more government in their lives.
       Everday Americans, who have the most at stake with 
     legislation that would nudge medical insurance coverage to 95 
     percent of the population by 2000, are asking reasonable 
     questions about cost and services. They want to know why 
     government wants a substantial role in running the health-
     care system, which accounts for one-seventh of the U.S. 
     economy. People naturally are skeptical--a necessary 
     predisposition among those who want to keep their liberty. In 
     fact, two-thirds in a Newsweek poll say it would be better to 
     wait until next year to tackle health-care reform.
       In response, the administration has lumped all who have 
     doubted the benefits of the Clinton health care bill as 
     nearly traitors.
       This is what Mr. Clinton said over the weekend: ``The 
     violent, extremist interests in this country that are trying 
     to keep health care out of the reach of ordinary American 
     working people are a disgrace to the American dream.''
       Some would say this outburst was frustration borne of a 
     struggle to make life better for citizens.
       But why make excuses? It's uncalled for and shifts 
     attention away from the merits of the case for reform.
       There are alternatives on the table that could do some good 
     without starting from scratch--for example, portability of 
     health insurance from job to job, insurance pools for pre-
     existing conditions and those struck by catastrophic illness, 
     and incentives to stay well instead of traipsing to the 
     doctor with every sniffle. On these issues, there is near 
     unanimity, and they are doable and affordable.
       Still, some within the administration aren't reading from 
     the same page of the hymnal. ``Tinkering around the edges . . 
     . will not work,'' said Health Secretary Donna Shalala.
       Congress has time yet to use politics in the best sense--as 
     the art of the possible. Compromise on health-care reform 
     will serve the interests of most of the public. Congress 
     should stay in Washington until they vote on a plan, and 
     voters will decide in November whether they did too much or 
     too little.

       ``Our View'' is the opinion of the Plainsman's editorial 
     board: Publisher Daryl Beall, Editor Cliff Hadley, Managing 
     Editor Roger Larsen, Associate Editor Dave Harles and 
     Regional Editor Crystal Pugsley.
  Mr. PRESSLER. Mr. President, I have held several meetings in recent 
months on the issue of health care reform. As always, the advice 
obtained from these meetings is valuable. A comment from one farmer 
stands out in my mind. He told me a story about a farmer who had 10 
pieces of farm equipment. Every spring he would take them out of the 
barn and get them ready for the spring work. He would overhaul only 
those machines that needed overhauling. He would just tune up the 
others. That is how we should proceed on health care reform. Let us fix 
that which is broken and leave alone the elements that work.
  I want to air some of my concerns about the ``full-court press" to 
pass a health care bill before the American people have adequate time 
to digest the details. I am not opposed to moving right along. A year 
ago in April, I said we should start voting on health care reform. In 
fact, I would like to start voting today, if we could, because we all 
have about as much information as we are going to get.
  I am concerned that political motives are the driving force behind 
this push. I am concerned that the mission of the Democratic leadership 
has been to get a health care bill--any health care bill. As I 
mentioned, in April of 1993, Senator Specter and I came to the Senate 
floor and said, ``Where is the bill?'' President Clinton had failed to 
meet his goal of giving us a health care reform proposal within the 
first 100 days of his administration. Our point was simple: Health care 
reform had been debated long enough. It was time to start voting in the 
Senate.
  Let me say that it is very ironic that the Senate has not had any 
real votes on this issue. It seems that the legislative process 
normally would be that the Finance Committee would pass a bill, which 
they did, and that bill would come to the floor, and we would have 
amendments--perhaps an amendment every hour--for several days, and the 
Senate would work its will. But that is not happening because the 
majority party's own Members would not vote for the bill. They would 
lose their own Members on the amendments. So, therefore, we are in the 
position of negotiating behind the scenes with different bills popping 
up here and there.
  Why do we not start offering amendments and vote every hour, letting 
the Senate work its will, instead of negotiating behind closed doors?
  Well, the reason is, the majority party does not have the votes. If 
the Mitchell bill were brought up on the floor this afternoon, it would 
be defeated, not necessarily by Republicans, but by a bipartisan 
coalition. Indeed, I have read in the papers that Senators from my 
neighboring rural and small city States have raised serious concerns 
about the Mitchell bill.

  What if we brought a group of political science students to watch the 
Senate of the United States today, or this week, while we are debating 
health care reform?
  This would be a very strange demonstration of our legislative process 
for them to witness.
  It is the opinion of this Senator that we should have proceeded in 
the normal way, brought the Finance Committee bill to the floor, began 
to offer amendments on it, and voted on those amendments with a time 
agreement of an hour.
  This is a very bizarre August situation in which we are staying in 
session longer, supposedly to pass a bill. But the people in the 
galleries and the people watching this process do not see any 
amendments, they do not see any votes being taken. What is going on 
here? Our side has not filibustered. Why does the Senate not work its 
will? The reason is because the majority party does not want to vote. 
They want to maneuver around to a position where they can blame the 
Republicans if they do not get a bill. It is not a constructive 
process.
  I would much rather be recorded on votes every day than be giving 
this speech, after which there will be no vote. There will be one vote 
today, and that is essentially a bed check vote. We are going to be in 
session next Saturday. We were in session all day last Saturday, and 
there was not a single vote on anything. But, we are showing the 
country how hard we are working.
  So let us remember who is doing this and how strange it is and how 
sad it is. This is not the way the Senate and the House are supposed to 
function.
  We may not start voting until September, and then the bill would be 
brought to the floor in such a way that individual votes would not be 
allowed on certain issues.
  The situation is similar in the House. The Rules Committee prevents 
the House from voting on a lot of tough issues, and then the bill is 
put into a big package in which the detials are concealed. This is why 
the public is disgusted with Congress.
  In any event, it is ironic that the biggest proponents of the 
Mitchell plan argue they need more time. They argue the issue is too 
complex and last year was not the time to vote.
  Several weeks ago, the President and the Democratic leadership 
declared the Clinton plan dead. They did not take a single vote on it. 
Why did they not bring it up for a vote?
  They did bring the Clinton plan up for a vote over in the Ways and 
Means Committee in the House, and the majority of the Democrats voted 
``present'' because none of them wanted to vote on record for it. That 
is what happened.
  This is very strange in a democracy, for here in Congress we have all 
these negotiations going on behind closed doors with no votes. Let us 
face the facts. The Democratic Party controls the House, the Senate, 
and the White House. They can start votes any time they wish. I wish 
they would.
  The Democratic leadership indicated they were taking a new approach 
to reform. This would be less bureaucratic and less confusing than the 
President's plan, we were told. The legislation we are debating now was 
unveiled a week ago. It is some 1,410 pages and weighs 14 pounds. No 
hearings have been held on this proposal. The American people do not 
know what is in the bill. Things have not changed. It calls for more 
Big Government and higher taxes. And the American people are not being 
told these facts.
  President and Mrs. Clinton should be commended for their role in 
bringing the health care issue to the national forefront. In fact, the 
First Lady was in Lennox, SD, last February. She is impressive. She 
understands the issues. She listened tirelessly to hundreds of South 
Dakotans discuss the shortcomings of our current system, although I 
must say that the Clintons' exact proposals for changing it were not 
very clear.
  The portions I have read of the Clinton-Mitchell bill convince me 
that it is bad medicine for South Dakota. It will hurt my State. 
Apparently the Democratic Senators from Oklahoma, Nebraska, and North 
Dakota have decided the same thing, as I as a Republican have decided, 
because they have raised serious concerns about the Clinton-Mitchell 
bill.
  Does this mean that I oppose reform? No. Does this mean that every 
provision in the Clinton-Mitchell bill is flawed? Of course not. 
However, in totality, the Clinton-Mitchell bill is the reconstituted 
Clinton plan, which would result in more taxes, more bureaucracy, more 
government and lost jobs.
  The bill is bad for South Dakotans for several reasons, including:
  More government.
  The Clinton-Mitchell bill would result in the creation of at least 50 
new Government agencies and offices. The Multinational Business 
Services, Inc., completed a study of the original Clinton bill. This 
group concluded that the President's plan would result in the creation 
of 98,000 new bureaucrats, 59 new Government offices, and 4,348 pages 
of new Federal regulation.
  Proponents of the Clinton-Mitchell bill claim that the new plan is 
less bureaucratic. Do not be fooled. It would create more Government 
bureaucracy.
  More Taxes.
  The Clinton-Mitchell bill includes 17 new taxes. Some examples 
include: a 1.75-percent tax on all health insurance premiums, a 25-
percent tax on all high cost premium plans, and a requirement to force 
all State and local government officials to pay Medicare taxes. No one 
would be exempt from these taxes.
  Rural areas.
  The Clinton-Mitchell bill would hurt small cities and rural areas.
  Why? The plan would cut Medicare by $278 billion over the next 10 
years. The bill indicates this on page 723. South Dakota hospitals, 
particularly those in rural areas, are dependent on Medicare for their 
survival. Cuts of this magnitude would force hospitals to close.
  The Clinton-Mitchell bill does not allow the self-employed to deduct 
the full cost of their health insurance premiums. Truckers, farmers, 
and ranchers tell me the best tool to help them purchase insurance is 
to make their insurance premiums tax deductible.
  Finally, the Clinton-Mitchell bill does not allow individuals to set 
up medical savings accounts.
  Employer mandate.
  Regarding the employer mandate, any requirement mandating employers 
to pay the medical insurance costs of their employees would result in 
lost wages and lost jobs.
  A study by the American Legislative Exchange Council projected 2,900 
South Dakota jobs would be lost if the Clinton employer mandate were 
implemented.
  Another study indicates that 52,545 South Dakotans would experience 
annual wage reductions of $1,200 for a family of four.
  Standard benefits package.
  All Americans would be required to obtain an identical benefits 
package. This package includes abortions.
  There are many Americans, both pro- and anti-abortion, who do not 
want the Government to set up abortion clinics. They do not want 
taxpayer dollars to fund abortions on demand, which is essentially what 
the Clinton-Mitchell bill provides for. There are many people who are 
pro-choice who disagree with this massive new Government abortion 
program. We should consider this viewpoint.
  More entitlements.
  Under the Clinton-Mitchell proposal, some 100 million Americans, 
families and individuals with incomes under $35,520 or 240 percent of 
the poverty level, would be eligible for a subsidy to help pay for 
their health insurance. One out of every 2.5 Americans would receive a 
Federal subsidy.
  In short, the Mitchell bill and the Clinton plan from which it is 
derived, is too costly, too bureaucratic, and will increase taxes.
  We need to make some changes in our health care system. We do not 
need to overhaul the entire system. We need to fix what is broken.
  Now let me say what I am for. I did not get elected to the Senate 
just to oppose things. I am for a positive program. In any event, the 
health care reform should include:
  Universal access to health insurance;
  Insurance reforms, including insurance coverage that cannot be 
canceled;
  No denial of coverage for preexisting conditions;
  Voluntary purchasing pools;
  Revision of medical malpractice laws, including caps on attorneys 
fees and a $250,000 limit on noneconomic damages;
  Abolition of unnecessary paperwork;
  Reduction of Federal regulations;
  Modification of antitrust laws;
  Subsidies to help the poor purchase private insurance;
  Establishment of medical saving accounts; and
  Full tax deduction of medical costs, including insurance premiums, 
for the self-employed.
  Mr. President, the health care reform legislation we are considering 
is extremely complex. We would be well-advised to be careful in writing 
this bill. As everyone should know by now, we are talking about one-
seventh of our economy.
  If we are at all unsure about the consequences of our votes on the 
cost an quality of health care, we owe it to the people to vote no or, 
at least postpone making certain decisions until more information is 
available to us. It is within our power to recognize and act upon those 
specific problems about which all of us agree.
  We can have a bill that fixes those commonly recognized problems. We 
can set aside what is now caught up in extreme controversial--mandates 
new bureaucracies, and higher taxes.
  In conclusion, Mr. President, let me say that this Senator believes 
the Senate should proceed the old fashioned way. We should have taken 
the Finance Committee bill, brought it to the floor, offered amendments 
and voted on it.
  This Senator would not object to a vote every half-hour, with 15 
minutes equally divided, so that the Senate can work its will. This 
Senator thinks it is very strange that the Senate and the House are 
proceeding in this manner.
  I want to legislate. For a year, since last April, I have said, let 
us bring legislation to the floor and the Senate will vote. That is 
what we are supposed to do. That is my judgment.
  Let me also say that we have the best health care delivery system in 
the world. I think it needs some reform, some fixing, some tuning up, 
but let us not throw the baby out with the bath. Let us proceed to come 
up with a bill that will solve the problems without hurting the main 
body of our health care system.
  But let us begin to vote. Let us begin to legislate. That is what 
Senator Specter and I said on the floor a year ago in April. This 
Senator is ready to go.
  Mr. President, I yield the floor.
  Mr. MOYNIHAN addressed the Chair.
  The PRESIDENT pro tempore. The Senator from New York [Mr. Moynihan].
  Mr. MOYNIHAN. Mr. President, may I offer my congratulations to the 
Senator from South Dakota for his statement that it is time to start 
voting. And may he have much influence on that side of the aisle, which 
I know he does, although it may not be on this particular point. But we 
are in complete accord.
  Mr. President, I have the great pleasure to yield to my friend, the 
learned Senator from Nevada, as much time as he may require.
  The PRESIDENT pro tempore. The Senator from Nevada [Mr. Reid], is 
recognized for such time as he may require.
  Mr. REID. Mr. President, you and other Members of this body were 
present today when the majority leader pointed to his desk and he said, 
``No matter how many times you call this desk a horse, it will never 
become a horse. Even though if you repeat it often enough, there will 
be some who believe this desk that stands in front of me now would be a 
horse, it is not. It is a desk. It is a wooden desk.''
  I say to my friend, through the Chair, the senior Senator from South 
Dakota, that he should check with the leadership on that side of the 
aisle. We are ready to vote. We have an amendment that is now pending 
to this legislation.
  But I sat on this floor Saturday and Friday and heard the 
distinguished minority leader say, ``We need more time. We have only 
had 11 or 14 Senators on our side that have been able to make 
statements about the bill. Therefore, go slowly.''
  In fact, one Senator stated he was not ready to proceed at this time. 
He needed more time to study it. And it was at that time that the 
dialog on the Senate floor came that there had been some 85 hearings on 
health care on this side of the Capitol; reams of reports.
  We are ready to go forward, Mr. President. I have some amendments 
that I would like to offer. There are others that would like to offer 
some amendments to the bill that is pending before this body.
  I also say that I disagree also with my friend from South Dakota. I 
think a political science class from high school, college level, 
whatever level, would be very instructive for students to come to this 
body today, tomorrow, or had they been here last week. This is what our 
country is all about. The legislative process is the art of compromise.
  We are trying to work out legislation based upon a bill reported out 
by the Labor Committee and a bill reported out by the Finance 
Committee. The majority leader has taken what he feels is the best of 
both bills. He has taken what he feels is the best of the Clinton 
proposal. He has been working with the House leadership and he has 
given us a bill, something that you can look to and read about.
  That is much different than I hear on that side of the aisle. We have 
people on that side of the aisle stand up and say, as they have--not 
all of them, but most of them--``We want a bill that contains costs, 
that allows portability, that would not prohibit insurance being 
offered as a result of a preexisting condition,'' and all these buzz 
words. But where is the legislation?
  What they have now, the bill offered by the Senator from Kansas, the 
minority leader, does not cover that, does not take care of that. So 
where is this ideal piece of legislation that they want?
  And again, I refer, Mr. President, back to the majority leader. This 
is a desk. This is not a horse. And no matter how many times you say it 
is a horse it is not going to be a horse.
  On the other side, one of my friends who I work with, the junior 
Senator from Oklahoma, I serve with him on the Appropriations 
Committee, work with him on the Interior Subcommittee; I have great 
respect for his ability. However, his saying that we do not have 
medical malpractice reform in the Mitchell proposal means that he has 
not read the bill or that staff has not advised him of what is in this 
bill.
  Again, this Mitchell proposal relating to medical malpractice 
insurance does the possible, not the impossible. They can talk all they 
want about the ultimate in medical malpractice reform, but what we have 
in this bill on page 1,037 is medical malpractice reform.
  Mr. President, I know a little bit about medical malpractice 
litigation. Before I came here, I did quite a bit of it. I defended 
doctors and I prosecuted claims for people that were injured.
  This is pretty good reform; not the ultimate, but pretty good reform. 
It sets up a program. First of all, it limits contingent fees. People 
say, ``What is that?'' It is a lot. It limits contingent fees to one-
third of a claim up to $150,000 and anything over that is 25 percent.
  The reason that is important, in Nevada--and we are not different 
than a lot of States--in Nevada sometimes attorneys took 50 percent 
contingent fees; 40 percent on a medical malpractice case was not 
unusual at all. So this is significant reform.
  It also set up, Mr. President, every State, it is mandated under the 
Mitchell bill that they set on a State basis, because one of the things 
we do not want to do in this area of the law is take away States' 
rights.
  What this does is mandate in a State that they set up an alternate 
dispute system for medical malpractice cases. It does not tell them 
what they have to do, but that they set it up. And before you can 
prosecute a case, you have to file a certificate saying you have been 
attempting to comply with that.
  I am not going to go into all that is in here with regard to medical 
malpractice. But it is significant reform. And no matter how many times 
on the other side of the aisle they say there is no medical malpractice 
reform does not mean it is true, because it is not true. There is 
medical malpractice reform
  Mr. President, I have heard a number of people say today that we have 
the greatest health care delivery system in the world; what we need to 
do is tinker with the edges, refine it a little bit.
  I acknowledge we have a great health care delivery system in this 
country. But it is in trouble because it is bankrupting us.
  The State of Nevada has had to call two special sessions of the 
legislature because of escalating health care costs.
  What is driving the deficit on the national level? Health care costs. 
So, we have to do something about it.
  This year, Mr. President, health care costs in America will go up 
over $100 billion--not $100 million. This year, 1994, health care costs 
in our country will go up over $100 billion, and we will not have 
better health care as a result of that. It is going to bureaucratic 
red-tape, Government and insurance company red-tape, and fraud, waste, 
and abuse. The Mitchell bill goes to the heart of that. The Mitchell 
bill will not cut out all the waste, fraud and abuse, but it will get 
to a big chunk of it. It will significantly damage those who like red-
tape.

  It does a great deal. For example, I have heard a couple of people on 
the other side of the aisle complain about commissions being set up. It 
was interesting to see, from the first speaker to the second speaker, 
the number of commissions dropped by 28--not by 28 percent, by 28. They 
went from 48 to 20.
  But regardless of that, we could look at each one of them, 
recognizing that the purpose of the Mitchell plan is to do away with 
Government inefficiency, to get Government out of health care delivery 
systems. For example, Medicare and Medicaid, that will be privatized 
under the Mitchell plan. I think that is important.
  I think it is also important to indicate we want to do away with the 
power of the insurance industry as it relates to health care. I will 
bet every Senator, and certainly every Senator's office, has heard time 
after time from physicians saying, ``I am tired of not being able to 
practice medicine. I have to get it cleared with an insurance clerk or 
some other clerk who is going to tell me whether or not I can do a 
procedure.'' We need to get away from that, and the Mitchell plan does 
that. For example, in the majority leader's legislation now pending 
before this body, there is something set up called the National Quality 
Council. This is important because we want to make sure, after this is 
all over with, we have better quality medicine delivered and the 
consumer is protected more than previously. This national council will 
establish performance measures for health plans, including measures of 
access, waiting times, patient-provider ratios.
  What that means is help if you are going to choose a health plan. 
When I choose one, I am part of 9 million other Federal employees. That 
is how many are in this Federal plan that the Presiding Officer, I am 
sure, and other Senators and staff in this Chamber--that is how many 
people are involved in that, 9 million Members. We have a so-called 
open season, when each year we can pick a new policy. I would like to 
think I am fairly sophisticated in being able to understand difficult 
things. I cannot understand it. I do not know what all those policies 
mean. But if we had this, I would be able to understand because I would 
be able to tell, for example, for open heart surgery, what is the 
survival rate. You can compare plans. Institutions would have to put 
that out. If you have a particular plan, there would be a determination 
as to how long patients have to wait, on an average. These are the 
kinds of things that are in the Mitchell plan. And these are the kinds 
of things that will improve health care in our country.
  I was just responding to some of the statements that had been brought 
up by the two previous speakers on the other side of the aisle. I hope 
that, before this is all over with, we will have a coalition, a uniting 
of Senators on both sides of the aisle. I am very sorry he left--I saw 
the senior Senator from Minnesota, someone who will be retiring from 
this body at the end of this year. I know he has spent a lot of time on 
health care legislation in his career. I hope he will see fit to join 
with the majority leader in working out something in this legislation. 
He has the knowledge, and we really need his experience and counsel. I 
think it would be a shame if he left this body without having had an 
imprint on health care legislation.
  I say that to other Senators on the other side of the aisle. This is 
the time to get health care legislation. It is not the time to talk 
about how good it could be, but to do the possible. What can we do to 
improve health care reform in America today?
  What I wanted to talk about today is small business. On the other 
side of the aisle we hear the constant drone that the Mitchell plan is 
not fair to small business.
  Again, this is a wooden desk. It is not a horse. And no matter how 
many times they say that health care reform is unfair to small 
business, it will not sell because it is wrong. An indication of that 
is a telephone call I had last week, Thursday or Friday of last week. I 
had never heard the name before, but I got on the phone with a man by 
the name of Edward Atwell, from Reno, NV.
  Edward Atwell runs a business, a small business. He has 11 employees. 
He works awfully hard. It is the Big-O Tire Co. in Reno, NV. He sells 
tires and fixes tires. Again, I had never met him, did not know he 
existed. He called me and said, ``Senator Reid, I am a dyed-in-the-wool 
Republican, always have been. But I want you to know as my Senator that 
I want you and your colleagues to do something about health care reform 
for me.'' He said, ``I have 11 employees and I have health insurance 
for my employees.'' He said, ``It is very expensive, but I want to do 
that for my employees. But it is getting harder and harder to do it.'' 
And he said, ``The tire companies that have no health insurance have a 
competitive edge over me. Do something about health insurance reform. 
Do it for the small business community of America.''
  Well, Edward Atwell wants health care reform. Why would he be 
concerned as a small businessman? He is concerned because he knows that 
it is hard for him to get insurance, and he knows that once he gets it, 
it is hard to keep it. He has been fortunate. He has not had one of his 
11 have a heart attack, get pregnant, get cancer--because if they did, 
his policy would never be rewritten the next time. Just like my 
ophthalmologist in Las Vegas whom I went to see to get my new glasses. 
He says, ``Harry, you have to do something. I have 27 employees. They 
will not rewrite my policy because one of my employees got cancer. I 
cannot get them to rewrite it. I cannot find anybody to give me a 
policy for my employees.''
  That is why Mr. Atwell is concerned. Mr. Atwell pays about 35 percent 
more for the same insurance policy that big business pays. The same 
coverage, he pays 35 percent more. And, if that were not bad enough, he 
pays increases of 50 percent more than big business. So the mere fact 
you have insurance, if you are a small business person, keeps you going 
further and further in the hole. Mr. Atwell expressed, to say the 
least, his frustration with the skyrocketing premiums he has and the 
fact that he is having a difficult time competing. Small business 
owners who, like Edward Atwell, do the right thing, are penalized under 
today's system. That is only one of a lot of reasons why we have to 
change the system. Because they are paying for the health care of their 
competitors who do not provide insurance for their employees.
  If I marched in here with 51 Senators and we said, ``We have a plan 
for the American public and here is what it is. Everyone who wants to 
buy health insurance, or is lucky enough to work for somebody who 
provides health insurance--everyone who has health insurance, no matter 
how they get it, are going to have to pay for those who do not.'' The 
American public would say, ``What, are you out of your mind? What kind 
of system is that? I thought you were doing your best to represent 
us?''
  And I would say, ``That is the system we now have.'' And that is the 
system we have now. Right now, the insurance system we have in America 
for health coverage is one where those who have it pay for those who do 
not in the way of higher insurance premiums, higher hospital and doctor 
bills, and higher taxes for indigent care. That is an unfair system we 
have today and it should be changed.
  Under the plan submitted by the majority leader, small businesses 
would no longer be forced to pay 35 percent more than big business. The 
Mitchell bill creates purchasing pools to give individuals and small 
businesses bargaining power to get high-quality care and coverage they 
can afford and they can count on and not be canceled at whim as was my 
ophthalmologist's. Small businesses and individuals will be able to get 
coverage at the same rates as big businesses, and insurance companies 
will no longer be able to pick and choose who to cover. The Mitchell 
plan, in effect, puts the consumer back in the driver's seat for a lot 
of reasons.
  If health care costs had been kept under control--that is, if health 
care costs had increased at the rate of growth in our overall economy 
for the past 12 years--small businesses, if they had insurance, would 
be paying an average of about $1,300 a year less per employee for 
health care coverage. Small business premiums have risen as much as 50 
percent a year. This is from the U.S. Department of Commerce, a report 
they did in January 1994.
  More than 90 percent of small business owners agree that health care 
is becoming prohibitively expensive and is a serious business problem. 
There are 90 percent of small business people who feel like Edward 
Atwell of Reno, NV. About 60 to 65 percent of small businesses have 
health insurance, but those who have it say, help us some way or we are 
going to drop it. We cannot afford it.
  Nearly 70 percent of small business owners want to offer employees 
better health care benefits and agree all Americans have a right to 
basic health insurance. Small businesses, as I have indicated, Mr. 
President, now pay from 35 to 50 percent more than large firms for the 
same insurance. Large corporations can offer more benefits at a lower 
cost, thus, putting smaller firms at a greater disadvantage.
  Paperwork and administrative burdens on small businesses that offer 
employees coverage, costs firms as much as 40 percent out of every 
health dollar, while large firms average a nickel. So if you are a 
small business person, you have insurance, the administrative costs out 
of $1 paid eat up 40 cents; big business, a nickel. Small businesses 
can pay, as I have indicated, 35 percent more than large businesses for 
the same coverage. I mentioned that several times, but I have done it 
on purpose.
  By the year 2000, if we do not do something, health care costs may 
eat up as much as 60 to 65 percent of businesses' pretax profits. In a 
poll, the NFIB, who is not, for a lot of reasons, excited about health 
care reform because of the way their institution is set up, found that 
64 percent of small business owners would like to provide some or 
better health insurance to their workers.
  Let us talk about the plan that is now up at the desk submitted by 
the minority leader. The Washington Post reported:

       The Dole proposal supports reform in name while largely 
     avoiding it in fact.

  Small business under that plan would face higher costs. Edward Atwell 
knows that and other small business people know that. It does nothing 
to protect small businesses with more than 50 employees who can still 
see premiums rise dramatically if a few of their employees get sick. 
Small firms can continue to pay more for administrative costs than 
large businesses.
  The plan submitted by the minority leader exempts trade associations 
from community rating. This loophole, in effect, permits discrimination 
in premiums based on what the industry does. A small coal miner--there 
are lots of diseases involved in coal mining--they would have to pay 
more. No discounts for small businesses. Unlike that of the majority 
leader which provides millions of small business people the ability to 
have coverage for the first time, the plan of the minority leader 
offers no small business discounts.
  There is continuation, under the plan of the minority leader, of 
discrimination against self-employed individuals. Self-employed 
individuals are denied 100 percent tax deductibility until the year 
2000. Cost shift remains. Small business insurance rates would rise and 
small businesses are forced to share the cost of high Medicaid patients 
and other high-cost individuals.
  There are incentives for small businesses not to take responsibility. 
Under the minority leader's nondiscrimination provision, if a business 
provides any insurance at all to any of its employees, they have to 
provide it to their low-income employees as well, without any discounts 
to help them pay for the coverage.
  This will not work. And if it is a matter of choice, you know they 
are not going to have the insurance. If a business contributes any 
amount to their employees' insurance, even a minimal contribution, 
their workers would not be eligible for any low-income subsidies.
  Mr. President, for those who have suggested that the best policy may 
be--and this is my term, not theirs--to muddle through with only small 
incremental changes, our analysis, my analysis, suggests that the 
number of uninsured workers in small businesses will continue to grow. 
In the publication ``Health Affairs,'' they said:

       Thirty percent of small businesses currently providing 
     insurance will drop their insurance coverage because of high 
     cost.

  It is only going to get worse.
  We know that small businesses are the least likely to offer insurance 
today, in large part because insurance companies often limit small 
business access to insurance by refusing to cover some firms and 
dropping others from coverage whenever just one worker gets sick. And 
we have talked about that.
  Mr. President, this is not a rare situation where small business 
decides not to carry insurance. In the State of Nevada, there is a 
woman by the name of Rose Dominguez. Rose is a woman who is involved in 
a lot of activities in southern Nevada. She is very interested in the 
community. She is interested in her employees. She has a travel agency. 
But she had to arrive at a point where she could no longer carry health 
insurance for her employees. The names are myriad in the small State of 
Nevada.
  So, we know that small businesses pay at least three times for their 
insurance. They pay for their own employees, they pay for the 
dependents of their employees, sometimes, and third, they pay through 
higher premiums for the uncompensated care of other people. Higher 
insurance premiums, higher hospital and doctor bills, and higher 
indigent taxes for indigent care.
  The system, according to the Wall Street Journal, will only get 
worse. I quote:

       By using their clout with health care providers to demand 
     lower costs, big employers help squeeze out inefficiencies 
     but also stop helping hospitals care for those with no 
     insurance or with Government insurance. Those costs won't 
     disappear, however. As big companies shed them, insurance 
     premiums for smaller employers will be forced up.

  I appreciate very much the Senator from New York yielding time to the 
Senator from Nevada. I have brought out two points: Malpractice reform, 
and I gave one example of a commission that will be set up so that 
consumers will have a better understanding of the health care that is 
provided to them.
  I have also talked about small business. I have talked about small 
business because they need to be cut some slack, as told to me by 
Edward Atwell of Big-O Tires, Reno, NV. No matter how many times those 
who want to maintain the status quo, no matter how many times they say 
that we do not have health care reform in the matter now before the 
Senate, in the form of Senator Mitchell's bill, no matter how many 
times they say that, it will not work because it is not the truth. No 
matter how many times they say this desk is a horse, it does not 
matter, it is still a desk.
  Mr. MOYNIHAN addressed the Chair.
  The PRESIDENT pro tempore. The Senator from New York.
  Mr. MOYNIHAN. Mr. President, I congratulate the Senator from Nevada. 
I remarked earlier on his great learning in this field and I 
particularly thank him for the points about malpractice reform. It is 
so important to the medical profession, and not just the doctors, but 
the nurses and all the people involved that we take this opportunity to 
relieve them of a needless anxiety, but anxieties which can be 
pervasive. If anyone gets to know people in this work, you will find 
that is on their minds all the time.
  Mr. REID. Mr. President, if I can respond to the manager of the bill, 
I think we are trying to do the possible. I am a great supporter of 
having consumers have the ability to file a lawsuit and have their 
grievances redressed in a court of law. But still there are things that 
need to be done to make the system better.
  I have only talked about a few of the things in the Mitchell bill, 
but I think it is a significant step forward and I wholeheartedly 
support Senator Mitchell's attempt to reform medical malpractice.
  I appreciate very much the comments of the Senator from New York.
  Mr. MOYNIHAN. I thank the Senator. I yield the floor.
  Mr. PACKWOOD addressed the Chair.
  The PRESIDENT pro tempore. The Senator from Oregon.
  Mr. PACKWOOD. Mr. President, I yield such time as the Senator from 
Mississippi may require.
  The PRESIDENT pro tempore. The Senator from Mississippi [Mr. 
Cochran], is recognized for such time as he may consume.
  Mr. COCHRAN. Mr. President, I thank the distinguished Senator for 
yielding me time.
  It was interesting to me to read the accounts of the debates that we 
have had in the Senate in the New York Times and the Washington Post 
over the weekend. One writer for the New York Times talked about the 
misstatements and malapropisms and other errors that the writer 
perceived to have occurred in the debate during the discussion of the 
health care reform bill.
  One very interesting story was written by Dave Barry: ``The Power 
Trip. Washington Outsider Trashes Town.'' He talks about how there is 
nothing in Washington to make it look like the planet Earth. But then 
he talks about the health care debate and he did have this to say, 
which I am going to read. He says:

       For more than a year now, the Clinton administration, 
     Congress, and scores of special interest groups have debated 
     the health care issue with such intense passion that their 
     photocopying machines routinely burst into flames. This 
     debate, although bitter at times, has resulted in a broad 
     national consensus on two fundamental conclusions: 1. The 
     United States has the best system of health care in the 
     world, and 2. Something needs to be done about this.

  Well, he then goes on to talk in his humorous way, as only Dave Barry 
can, about many of the other things that have made it possible for us 
from time to time to laugh at ourselves. But this health care issue is 
not really a laughing matter. I will agree what Mr. Barry points out in 
his first conclusion and his assessment of the national consensus is 
right when he says the United States does have the highest quality 
health care--and, I might add, with more choices--than any other nation 
in the world. That will be put at risk by the Clinton-style plan 
proposed by the Democratic leader. That plan will result in higher 
costs, longer waiting lines, and endanger the health care choices of 
most Americans. The mandates, the taxes, the alliances, and the premium 
caps all mean sweeping new Federal controls over American medicine.
  Before we vote, we should ask: Do we really want to create this new 
Government-controlled health care program? And we should ask specific 
questions about their plan such as: What would the new overhead costs 
be?
  Senator Mitchell's bill would set up a National Health Care Cost and 
Coverage Commission and a National Health Benefits Board that would 
make many decisions about the kind of health care that would be 
available in the future to all American citizens, including decisions 
about medical necessity and appropriateness. Under this bill, many new 
State and Federal agencies would be established.
  We had first heard in a report, in an analysis from our distinguished 
colleague from Indiana, Mr. Coats, that there would be 20 new State and 
Federal agencies created under the Mitchell bill--now we are told that 
that could go as high as 70--and many mandates imposed on the States, 
177 new obligations imposed on the States, by this new Federal law if 
it is enacted. No one has been able to tell us what the new overhead 
costs of the program would be at either the Federal level or the State 
level. We also need to ask, we should ask: What has happened to the 
costs of the Federal health programs we already have?
  In 1990, Medicaid spending totaled $41.1 billion. In 1995, 
Congressional Budget Office projections indicate that Medicaid spending 
will total $105 billion. From 1990, $41.1 billion, to 1995, $105 
billion; a program we already have. This could be an indication of the 
kind of cost spiral we will see if the Federal Government were to 
administer our entire health care system.
  We should also ask about the costs of other entitlement programs and 
how much they have increased in costs during the past 30 years.
  I have a chart here--and I apologize for using a chart, but it 
clearly illustrates better than I can in just my statements--showing 
how entitlement costs have grown over the last 30 years.
  From 1963, if we look at this line here as illustrating 100 percent 
of the Federal budget--this is the total Federal budget line here from 
zero to 100 percent--the discretionary spending in 1963, that which the 
Appropriations Committee approved for allocation among all the Federal 
activities and programs, amounted to 70 percent of the total budget. 
Entitlement spending--Social Security, Medicare, Medicaid, other 
programs that were mandated by law, to which people were entitled as a 
matter of law--amounted to only 30 percent. In 1973, that had gone up 
to 45 percent, in 1983 to 56 percent, and in 1993, just last year, it 
reached 61 percent of the total Federal budget. And the projections are 
that even without this new health care plan, which will increase 
entitlement spending considerably, we will have a Federal budget that 
will require 72 percent of total outlays to go to support entitlement 
programs, and only 28 percent by the year 2003 that would be available 
for discretionary spending.
  A recent article in my hometown paper, in Jackson, MS, the Clarion 
Ledger--it was written by Miles Benson for Newhouse News Service--talks 
about this entitlement spending trend and what it means in the context 
of the health reform proposals before the Congress. He says:

       Over the years, the Government has promised a lot of costly 
     benefits to middle-class Americans and now it is trying to 
     make one more big one--universal health care. But where is 
     the money to pay for Social Security, Medicare, and a 
     plethora of previous promises? Their fast-growing costs, 
     along with interest on the national debt, add up to 60 
     percent of all Federal spending, even without the enormous 
     added expense health reform will bring. Unless changes are 
     made soon, the Government won't have enough money to continue 
     even the existing programs. And that means either higher 
     taxes or benefit cuts or both.

  He goes on to say, in another part of this article, which I will ask 
unanimous consent be printed in its entirety at the conclusion of my 
remarks, that:

       The fastest-growing entitlement programs are Medicare, 
     which helps 35 million elderly and handicapped people pay 
     their medical bills regardless of their income from other 
     sources, and Medicaid, which pays for doctors' care for 30 
     million. The costs of these two programs are expected to 
     increase at a rate of 10 percent per year over the next 
     decade, increases driven by the growth of the eligible 
     population, the increasing intensity of medical services 
     available to participants, and hyperinflation in the costs of 
     health care.
       Medicare hospital insurance payments already exceed tax 
     revenues dedicated to the program, and the trust fund 
     dedicated to the program will run out of money within seven 
     years unless something changes.

  And he concludes by saying:

       President Clinton insists his health care reform plan 
     would, over time, curtail the growth of health care costs, 
     but he also seeks to extend health care coverage to 39 
     million uninsured Americans financed partly by new Federal 
     subsidies. And he wants to broaden the benefits available 
     under Medicare and Medicaid. Many experts believe expanding 
     coverage will substantially drive up Federal spending on 
     health care.

  Mr. President, I ask unanimous consent that the entire article by 
Miles Benson of Newhouse News Service be printed at the conclusion of 
my remarks.
  The PRESIDENT pro tempore. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. COCHRAN. Mr. President, the Mitchell plan creates at least eight 
new entitlements. It commits the Federal Government to new entitlement 
spending which is estimated to be $1.5 trillion over 8 years. And, if 
it does not work to achieve the predetermined goal of coverage, then 
employers will be required by the new Federal mandate to pay one-half 
of the premium cost of their employees beginning in the year 2002.
  Somebody asked me, ``Why is this delayed? If you need the money now, 
why put it off for this long period of time?'' I frankly think the 
reason is political. One reason is that people who have to pay this tax 
will not know who voted for it when they have to pay it. I mean, we are 
putting it over from now, if it is enacted this year, to the year 2002. 
And those folks who are going to have to pay this new payroll tax, 
which is what the employer mandate turns out to be, are not going to 
know who is responsible. As a matter of fact, somebody suggested that 
may be why they called it a trigger. The trigger means that if they do 
know who did it, they might shoot them. But the fact is, if States are 
not up to the 95 percent coverage rate by the year 2000, those 
businesses in that State with 25 or more employees are going to be 
required to pay the new payroll tax.
  Who will that be? The National Federation of Independent Business has 
done a study trying to estimate and determine what States are going to 
be required to pay this added payroll tax. Not all States may be 
covered by it. But there is a way to figure out now which States are 
the most likely that have to pay. They did this list.
  Mr. President, Mississippi and West Virginia are at the top of the 
list. Utah, New Mexico, Arkansas, Louisiana, South Carolina, Montana, 
Idaho, and Oklahoma, and it goes on down through a long list of 25 
States that most likely will have to pay this tax. Ohio is the 25th.
  As a matter of fact, we have done this in a graphic so you can get an 
idea just by looking at a map of the United States. Almost the entire 
South, except Florida, is covered, and the Southwest out to Arizona, 
including New Mexico and Arizona, and the upper Northwest, except for 
the State of Washington, will be covered; some of the heartland States 
right here in the industrial Midwest, Indiana, Ohio, West Virginia, 
Kentucky. The fact of the matter is, do not forget Maine. They are one 
of the most likely to have to pay this tax too.
  What they have done is try to determine the number of people who are 
now covered by insurance in all of the States, and the per capita 
income of the residents of all those States to figure out for which 
States it will be hard to meet this predetermined 95 percent of 
coverage. These are the States. So they are the most likely to have to 
pay the tax.
  Where do you need the economic growth the worst? It is in many of 
these States. We need new jobs. We need to be attracting new industry 
into these areas to help provide jobs. But if you are going to have a 
new requirement now that employers in those States have a mandate to 
pay premium costs for health insurance and the other States do not have 
it, what is that going to do to your opportunity to attract new 
business, to create new jobs? I say it hurts it. It puts you at a 
disadvantage. That is what this mandate does, as far as economic 
development and the attractiveness of certain States as compared to 
others.
  Senators ought to think about that. Some say that the mandate is bad, 
it is bad for business, it may cost jobs, and it may be harmful to our 
entrepreneurial spirit as a country. If it is bad now, it certainly is 
just as bad in the year 2002 when it will be triggered, if this 
predetermined 95 percent of coverage is not achieved. Most think, 
obviously, that some States will not achieve it or cannot because of 
demographic differences, because of economic differences, and because 
of the realities that exist out there in the real world.
  Senator Mitchell's bill states that if a 95-percent coverage target 
is not achieved by the year 2000, the employer mandate would be 
triggered requiring businesses with 25 or more employees to pay 50 
percent of their employees' health insurance premium costs.
  Many experts tell us that these mandates, these new taxes, on 
selected States, would destroy jobs, threaten the survival of many 
businesses, and reduce wage growth. If mandates are a bad idea today, 
when they are triggered they will be a bad idea then.
  A triggered mandate only in States that do not achieve that 95-
percent coverage will hit the small business-intensive States the 
hardest. I do not know how many businesses will actually fold up. 
Nobody does. Those who cannot afford the new costs, because they are on 
a tight profit margin or maybe no margin of profit at all; there is no 
question that fewer new businesses would be started in those States 
that have to have the new tax. They have many other burdens imposed by 
the Federal Government already that cost money, that add to overhead.
  Studies conducted by Consad Research, the Urban Institute, and 
others, forecast anywhere from 700,000 to 3 million jobs will be lost 
as a result of the new employer taxes. A Gallup Poll of small business 
owners indicates that a majority of them would either let some 
employees go, restrict wage increases, or increase prices as a result 
of an employer mandate. No matter which job loss study you look at, 
they all point in the same direction--employer mandates cost jobs.
  I would suggest that another serious result could be that many small 
business owners will decide that it is just not worth the hassle to 
stay in business, and others who might otherwise consider starting a 
new enterprise would be discouraged from doing so, especially if they 
are in a State where the trigger has been pulled.
  When these new taxes and new regulations are combined with other 
burdens that are placed on small business by the Government, the 
American entrepreneurial spirit surely will be dampened, and our 
economic vitality will be put at risk.
  Mr. President, some of the rhetoric we heard has suggested that 
Republicans want to stop health care reform in its tracks. I think most 
Republicans in the Senate want to solve the problems in the health care 
system. We can do it by providing portability of coverage, and 
eliminating unfair underwriting practices, by providing subsidies and 
tax breaks to assist people in getting and keeping the coverage they 
want. Senate Republicans produced two comprehensive health care plans 
last year, one sponsored by Senator John Chafee and the other sponsored 
by Senator Don Nickles.
  This year, 40 Senate Republicans joined in support of Senators Dole 
and Packwood when they introduced their plan and also that also 
confronts the real problems that exist in today's health care system.
  The Dole-Packwood plan enhances quality, preserves health care 
choices, controls costs, and promotes security without imposing the new 
taxes that will unnecessarily burden small businesses and their 
employees.
  The Dole-Packwood bill has the greatest support of any plan in the 
Senate, including the proposal of President Clinton and Senator 
Mitchell.
  The Dole-Packwood plan would provide choice to ensure that consumers, 
and not the Federal Government, decide how they get their care, and 
from whom; preserve American jobs by protecting small businesses from 
job-destroying mandates and taxes; increase access and remove the fear 
of losing insurance because of job loss or job change, moving, or a 
serious illness; maintain quality to ensure America's health care 
remains the best in the world, and consumers do not pay more for less 
care; be financially responsible, by phasing in financing of reform as 
other savings are available and not through deficit spending or 
increased taxes; achieve flexibility by allowing States and localities 
options to design plans best fitting their particular needs.

  Mr. President, we should not adopt the Democratic leader's newest 
version of the Clinton plan, which would mean quotas on doctors and 
training; a premium tax on graduate medical education; Government 
spending limits that will lead to rationing of care, higher levels of 
taxation, new entitlements, and a big, new Federal bureaucracy.
  Before passing the Clinton-Mitchell bill, we should remember the 
enactment and repeal of catastrophic insurance in the Medicare program 
in 1988 and 1989. The lesson of this experience is that it is not 
enough to promise health care benefits to Americans. We have to make it 
clear how any new program will affect them and how much it will cost 
them, and we need their support. Last time out, we forgot to do that. 
We should not make that mistake again.
  I suggest when all the facts are understood, American citizens will 
prefer the Republican alternative, because it will mean less 
bureaucracy, less costs, more quality, more choices, and no new taxes.
  I urge the Senate to reject the Mitchell bill.

                               Exhibit 1

             Unless Action Taken, Retirement Means Poverty

                           (By Miles Benson)

       Washington.--Over the years, the government has promised a 
     lot of costly benefits to middle-class Americans and now it 
     is trying to make one more big one--universal health care.
       But where is the money to pay for Social Security, Medicare 
     and a plethora of previous promises? Their fast-growing 
     costs, along with interest on the national debt, add up to 60 
     percent of all federal spending, even without the enormous 
     added expense health reform will bring.
       Unless changes are made soon, the government won't have 
     enough money to continue even the existing programs. And that 
     means either higher taxes or benefit custs or both. The 
     middle class and the wealthy, who receive more than half the 
     benefits, will feel the pain, as well as the poor, and 
     there's very little anyone is going to be able to do about 
     it.
       The current generation of people in their 60s may be the 
     last generation to collect the full benefits now available 
     from Social Security.
       Rising health care costs, longer life expectancy, and the 
     advancing legions of 76 million baby boomers, who will begin 
     retiring at the end of the next decade, are setting the stage 
     ``an economic and social disaster,'' said Sen. Robert Kerry, 
     D-Neb., who wants President Clinton and Congress to begin 
     dealing with the problem now.
       The technical name for these benefits is entitlements, and 
     Kerry chairs a 32-member Bi--Partisan Commission on 
     Entitlement and Tax Reform. The commission will report its 
     recommendations in December.
       According to commission members, administration officials, 
     congressional budget experts, and numerous outside economic 
     experts, this is the reality the nation faces:
       If allowed to continue without change, entitlements plus 
     interest on the federal debt will consume all federal 
     revenues by the year 2012, just 18 years off, leaving nothing 
     for defense, disaster relief, law enforcement, air traffic 
     control or anything else--including the salaries of federal 
     workers who write the federal benefit checks.
       Financing the entitlements in their present form could 
     require a 50 percent increase in all federal taxes on current 
     and future generation of taxpayers--increases that would be 
     politically impossible to enact and, even if enacted, would 
     probably be self-defeating. The economy would collapse under 
     their weight.
       Deficit financing would be equally unrealistic. Such 
     deficits would dwarf even the monster deficits of recent year 
     years. blocking investments needed to boost productivity, 
     create jobs and raise living standards.
       Some combination of increased taxes and reductions in 
     benefit levels is inevitable, many experts, believe. These 
     solutions could include caps on spending or reducing benefits 
     to middle- and high-income people. Some economists are 
     studying the feasibility of new taxes on consumption.
       Today, entitlement programs automatically pump out benefits 
     to every eligible person who signs up for them. The biggest 
     are Social Security, Medicare, Medicaid and the federal 
     retirement system covering both civilian and military 
     retirees. These four programs account for 75 percent of 
     entitlement spending.
       The rest consists of much smaller programs that include, in 
     descending order of cost, food stamps supplemental security 
     income payments that go mostly to the disabled and to poor 
     elderly people, veterans benefits, welfare payments to 
     mothers and children, agricultural price supports and earned 
     income tax credits for the poor.
       This year, 1994, total entitlement benefits come to $800 
     billion. More than half of all entitlement benefits go to 
     middle-class and affluent Americans. In the case of Social 
     Security, the average retiree is getting back far more than 
     he or she paid in plus interest,--on average $40,000 more per 
     retiree over his or her lifetime.
       And under this system, families with private incomes of 
     more than $50,000 a year got $49 billion in Federal benefits 
     in 1990. About $12 billion of those benefits flowed to 
     families with income of more than $100,000.
       Last year, the 2.2 million federal civilian and military 
     retirees received benefits worth $65 billion.
       Many experts say those now in the 60s are the last 
     generation that will enjoy such a sweet deal. The generosity 
     of benefits will subside because there won't be enough money 
     to support them. And future retirees will have paid higher 
     taxes for a longer time than current retirees.
       Workers with average earnings who retired in 1980 got back 
     their retirement taxes--the share paid by themselves and the 
     share paid by their employers on their behalf-plus interest 
     in less than three years.
       When average-wage workers now in their late 20s retiree, 
     they will need more than 18 years to recover their 
     contributions--two years longer than their life-expectancy. 
     And that assumes the money will be there to pay them, which 
     it won't be if benefits aren't cut or the taxes aren't 
     raised.
       The fastest-growing entitlement programs are Medicare, 
     which helps 35 million elderly and handicapped people pay 
     their medical bills regardless of their income from other 
     sources, and Medicaid, which pays for doctors' care for 30 
     million poor. The costs of these two programs are expected to 
     increase at a rate of 10 percent per year over the next 
     decade, increases driven by the growth of the eligible 
     population, the increasing intensity of medical services 
     available to participants and hyper-inflation in the cost of 
     health care.
       Medicare hospital insurance payments already exceed tax 
     revenues dedicated to the program and the trust fund 
     dedicated to the program will run out of money within seven 
     years unless something changes.
       President Clinton insists his health care reform plan 
     would, over time, curtail the growth of health care costs, 
     but he also seeks to extend health care coverage to 39 
     million uninsured Americans financed partly by new federal 
     subsidies. And he wants to broaden the benefits available 
     under Medicare and Medicaid. Many experts believe expanding 
     coverage will substantially drive up federal spending on 
     health care.
       Social Security is the third rail for elected officials--
     touch it and you die.
       Social Security means regular monthly checks to 42 million 
     elderly and disabled and members of their families this year. 
     For millions of Americans, the benefits are all that 
     separates them from poverty. For additional millions of 
     already affluent elderly, the benefits are merely gold-
     plating on an already secure and dignified retirement.
       Thanks to lengthening life spans, the average couple 
     retiring today can expect to collect Social Security checks 
     for 25 years. The insurance value of that pension combined 
     with Medicare benefits is more than half a million dollars.
       Older people, one of the country's most potent blocs of 
     voters, are organized to fight any attempt to reduce 
     benefits. The flavor and intensity of the opposition is 
     evident in the blizzard of mail already pouring into the 
     entitlement commission's offices on Capitol Hill.
       ``If you intend to mess with Social Security, you all 
     should be thrown out of office,'' wrote one enraged senior. 
     ``It's our money, not to be used by you or no one.''
       Said another: ``Don't fool with Social Security. Don't try 
     balancing the budget with my money.''
       For now, the tax structure of the Social Security system 
     generates a surplus that reduces the federal deficit and 
     helps pay for other federal programs.
       But the surplus will disappear during the next 20 years as 
     the baby boomers retire and the payouts to them surge. Unless 
     changes are made, the Social Security trust funds will run 
     out of money to pay benefits to today's 20- and 30-year-olds 
     when they are ready to retire. Today's 40-year-olds would 
     drain the funds dry by the time they are 75 years old.
       Low birth rates and longer life expectancy mean that the 
     ratio of workers to retirees is shrinking. In 1950 there were 
     more than seven workers paying taxes to support the benefits 
     of each retiree. In 1985 there were five workers for each 
     retiree. Today there are four and by 2030 there will be fewer 
     than three.
       ``What it really boils down to is that revenues and 
     spending in our budget as a whole are out of whack, out of 
     balance,'' said Robert Reischauer, director of the 
     Congressional Budget Office.
       ``We can solve the problem by cutting back on entitlement 
     programs or cutting back on non-entitlements or by raising 
     revenues. The answer to the dilemma will be a little of all 
     three,'' Reischauer predicted.
       The problems are clearly visible now. They will be no 
     surprise when they erupt as full-blown crises--if nothing is 
     done now.
       ``If we do something modest and prudent now we can avoid 
     taking more drastic remediation 15 years from now,'' 
     Reischauer said.
       For example, putting the Social Security system into 
     balance for the next 75 years would require a 1 percent 
     increase in payroll tax on employees and employers, if that 
     is done now, Reischauer said.
       Meanwhile, younger workers cannot expect they will get as 
     much out of the system as current retirees.
       ``The system was very good to our grandparents and parents 
     and people retiring right now, because it represented a huge 
     intergenerational transfer,'' Reischauer said of the shift of 
     wealth from the young to the old. ``But that will not be true 
     in the future unless life expectancy takes another big 
     jump.''
       In the mid-1930s, when Social Security was established, the 
     average life expectancy was 60 years. Today it is 76. Under 
     current law, the age for full benefits retirement will 
     increase gradually from 65 to 67 between the years 2000 and 
     2017.
       Crusaders for sweeping entitlement reform, like Peter G. 
     Peterson, former Secretary of Commerce, and former senators 
     Paul Tsongas, D-Mass., and Warren Rudman, R-N.H., urges 
     raising the retirement age to 68 to 2006, reducing Social 
     Security and Medicare benefits to retirees with incomes above 
     $40,000 a year on a sliding scale as incomes go up.
       Reform of the Social Security System, in both the financing 
     and the benefit, is ``inevitable'' said C. Eugene Steuerle, 
     an economist at the Urban Institute, a public policy think 
     tank.
       ``Social Security will be there and remain a fairly 
     generous system, but we must cut back on some of the built-in 
     growth,'' Steuerle said. The budgetary problems are self-
     induced, the result of the fact that people are living longer 
     and getting better health care. ``In a crazy way, it's a nice 
     set of problems to have,'' Steuerle said.
       But changes must be made, he warns.
       ``Every year of delay in resolving these issues will make 
     the required changes harder and harder to bear,'' Steuerle 
     said. ``Expected liabilities are accumulating quickly 
     relative to assets and anticipated revenues. The longer that 
     reform is delayed, the greater the adjustments required of 
     beneficiaries and taxpayers.''

  Mr. RIEGLE addressed the Chair.
  The PRESIDENT pro tempore. Who yields time?
  Mr. RIEGLE. I yield such time as I may consume off of the time of the 
majority.
  The PRESIDENT pro tempore. The Senator is recognized for such time as 
he may consume from the time under the control of Mr. Moynihan.
  Mr. RIEGLE. Mr. President, let me just say that when the Senator from 
West Virginia assumes that position, there is no finer Presiding 
Officer.
  This issue that we are here to try to deal with--namely, health care 
for our country--is a vital issue for our people. It certainly is in 
the State of West Virginia, where the President pro tempore comes from, 
and in my home State of Michigan. I know there is great frustration in 
the country as this debate has gone on now over several days in the 
Senate. I think citizens listening to this and watching think that 
probably all we do is talk and that nothing more than that happens, or 
at least not as often as it should.
  I think we are reaching a point in this debate where a lot of the 
words are more for effect and have a purpose other than trying to 
settle the issue, because this question of health care reform has been 
around a long, long time. It goes back, in fact, for decades.
  One of the prior Presidents had offered a plan very similar to the 
Mitchell bill or the Clinton bill that has been put forward. It was 
President Nixon, who at that time was a Republican President; but to 
his great credit, he saw the need to try to reform the health care 
system, to make it less expensive, less bureaucratic, and try to make 
sure everybody had a chance to have insurance, especially working 
families, so they could protect their children and all their family 
members.
  I must say that over the last 2 or 3 days, the debate has taken on 
much more of the character and feeling of a filibuster--namely, a 
tactic of delay, rather than actually getting down to and voting on the 
basic aspects of a health care reform plan.
  We actually have an amendment on the floor right now. It has been 
presented at the desk, and we are ready to vote on that. It is offered 
by Senators Dodd, Kennedy, and myself, and I believe there are other 
cosponsors. It is designed to expedite coverage of preventive health 
services for children and pregnant women in our country, to make sure 
these services are the first covered in the standard benefit plan--in 
July of 1995, instead of January of 1997. Those, today, in working 
families who do not have the protection of comprehensive insurance will 
get it under this plan. So that is the first amendment. It has actually 
been sent down to the desk. It is in writing and is down there right 
now. If this odd kind of filibuster were to stop, we could vote on that 
in the next 10 minutes, and we could find out where Senators are. There 
are 100 of us here, and we all have the chance to vote and settle that 
issue, and then we would be ready for the next amendment. And that 
might be an amendment from the Republican side. They could come to the 
floor and present it, and we could have a period of debate on that and 
then vote, it either wins or loses, and that issue is settled and we go 
on to the next issue. We can work through these issues, I think, and 
get them done this week, if Senators were willing to actually decide 
these questions rather than just use endless debate as a delaying 
tactic.
  I want to talk a little bit about the amendment we actually have at 
the desk and what it is designed to do. I want to make reference, as I 
have before, to an article that ran some time ago in the Detroit 
newspaper in Michigan. It is a story about a woman named Cynthia Fyfe. 
There is a picture of her here, and this is her 6-year-old son Anthony 
in the lower part of this picture. He is wearing glasses. Obviously, he 
needs them and fortunately has them. This article says, ``She Can't Pay 
Her Big Medical Bills.'' It goes on to explain in the text of this 
story her situation. She is a single parent, a working mother, as are 
millions of women in America today. She has partial insurance at her 
workplace for herself, but none for her 6-year-old son, Anthony. In 
fact, their health insurance is so inadequate that when she got sick, 
she had a lot of expenses associated with the care that she needed, and 
her health insurance did not cover most of it. So now she owes nearly 
$3,000 in medical bills, and she cannot pay.
  It talks here about how they live very modestly, in a trailer park, 
and she uses just about every cent she has just on the bare essentials 
of food and clothing and shelter for herself and her son. But Anthony 
does not have any health insurance. This little fellow right here, and 
millions more like him in our country today, have no health insurance 
at all. So if he gets sick and she has to take him in for care, whether 
it is to a specialist or, God forbid, if he were stricken with 
something very serious like appendicitis or such and she had to take 
him to the hospital for acute care, she has no insurance that can cover 
those expenses. So, obviously, he is unprotected. And people in this 
situation are also oftentimes reluctant to take their children in for 
care when they need it, because they have no way to pay the bills. That 
is the situation here.
  The irony of it is that if Cynthia Fyfe would quit her very modest-
paying job and go on welfare, go on public assistance, then she would 
receive health care coverage; she would receive it under Medicaid, and 
so would her son, Anthony. So one way she could get health care 
coverage for her son is to actually quit her job and go on welfare and 
then, under our system, we would provide health insurance to this 
little 6-year-old boy in Detroit.
  When you hear that, you almost wonder if you are hearing right. Can 
it be possible that in America we have things so upside-down that we 
say to a mother who is out there working, who obviously loves her child 
and wants to provide health care insurance coverage for her child, that 
if she cannot earn enough to be able to pay for it, that if she will 
quit her job and go on welfare, then we will see to it that she can 
have health insurance for herself and also for her son?
  That is what we are trying to fix here. It is not that complicated. 
It is pretty darn simple, although we have heard a million words spoken 
here over the last 4 or 5 days since this amendment has been sitting 
down at the desk. But the amendment is very straightforward. It has to 
do with seeing to it that we provide comprehensive coverage for these 
children in America who today do not have comprehensive care.
  We are not talking about frills. We are not saying let us enable this 
child to go down to a fancy department store and pick out a whole 
wardrobe or have some fancy house to live in or to give someone a big 
car to drive.
  We are talking about something a lot more basic and a lot more 
important than that. We are talking about the question of making sure 
this little kid has a chance to grow up and be well and healthy in 
America, which every child in America ought to have the chance to do, 
because every child in this country is important. You should not have 
to be born into a certain family situation or to be in a favored status 
in some way or another to be important enough in this country as a 
child to have health care protection. Every child should have it, 
because every child is important.
  If we were driving down a highway right now and we came upon the 
scene of an accident that had just happened ahead of us, a car had gone 
off the road and a terrible accident happened and people had been hurt, 
and if there was a child there by the side of the road needing help, 
would we just drive on by? Would we just drive right on by that child 
and keep going? Of course, we would not. We would stop, and we would 
get out, and we would help. You would try to save that child's life and 
see that that child got the care it needed.
  But as a country right now we are driving right on by these children. 
It is as if they are not really there or--we obviously know they are 
there--it is as if they do not really matter or they do not matter 
enough.
  But what is this country? What is America? Is it just this great big 
piece of real estate? Is it just something we call a country that we 
started over 200 years ago? That is part of what we are. We are a 
nation of people, and we are bound together in this Nation in a 
relationship to one another where the well-being of America, our 
country, in the future depends upon how our people are able to live. 
Can they work? Can they get an education? If they are living in West 
Virginia, do they have a chance to take the talents that they have 
within themselves and develop those talents? Or if they are in 
Michigan, or one of the other 50 States, do they have the chance to 
come forward and make of themselves what they can?
  But if you need eyeglasses or you need to go to the doctor or you 
need your immunization so that you do not get some dread sickness, or 
as in the case that we have seen in my own family circle when my 
daughter Ashley, nine and half when it was found she had a terrible 
appendicitis, nearly died, the doctors could not figure it out for a 
while. Thank God, she got the care in the end that enabled her to 
survive.
  There are kids across the country right now with problems like that. 
Anthony needs help. How important is he? Is he important enough for us 
to do something about?
  I think we ought to vote on this amendment and do something about 
helping children like this, because this matters. This is important. It 
is real. It is tangible, and it will make a difference in terms of 
making our country stronger for the future.
  You say, well, wait a minute. You are just talking about this little 
6-year-old boy and are now talking about the country being stronger. 
What is the connecting link? The connecting link is that our country in 
the future is going to have this little fellow, and boys and girls all 
across this country--they are what our country is. They are our future.
  So we want them well and healthy and strong. We also want them well 
educated. We want them to be able to go into the work force at a point 
in time to support themselves and to support the country and strengthen 
the country. That is what we want. I think that is why we came and 
formed this country in the first place. It was for those kinds of basic 
things.
  Now, what is so ironic is that every other country in the world, 
every other advanced country in the world and many of the not very 
advanced countries in the world have decided this issue is so basic 
that they provide health insurance coverage one way or another for 
their children because they understand the importance that those 
children have to their Nation.
  But there is another part to this. I mean, our people are the heart 
and soul of this Nation. We want them well and healthy and able to 
function at full potential. But there is another part to this, and that 
is just the basic humanity and decency of it and whether we care about 
whether other people suffer, whether someone else's pain matters to us.
  Well, on that count, I am thoroughly one of those people who feels 
strongly about other people that I see who suffer needlessly. It 
bothers me. I do not have to know who they are. They do not have to be 
from my town. They do not have to be my race. They do not have to be my 
gender. Whoever it is, if I see that, I feel badly about it, and I want 
to do something about it. I want to help that person get out of that 
situation of pain or misery or danger to their own well-being.
  I do not understand why everybody does not feel that way. But some 
feel it more strongly than others obviously. But I think we ought to 
help people who need help because it is the right thing to do. I do not 
think we ought to leave people in pain. Today we have an epidemic of 
breast cancer in this country. I do not think we ought to leave women 
in this country with undiagnosed breast cancers because they do not 
have the money to get regular preventive care and get mammograms and 
other things they need to find out if they have this problem so it can 
be dealt with in time to save their lives. The same with other 
problems, but especially with the children, because the children are 
very vulnerable, and they cannot fend for themselves quite the same 
way.
  This little fellow right here, if he had the strength and the ability 
to give his mother two or three times the income that she now has so 
they could live at a higher standard and have health care, surely he 
would do it, but he is 6 years old. He cannot do it. He cannot do it 
for her, and he certainly cannot do it for himself. But we can do it 
for both of them, and we ought to because it is decent and because it 
is good for the country. It will make us stronger and better as a 
nation. We want this little kid to succeed. We want him to know his 
country cares about him.
  Well, there is a way for us to let that message come through loud and 
clear, and it is to vote for this amendment that is at the desk right 
now that has been there for 4 days. Some tried to talk it to death. Let 
us vote on it. If you want to vote against it, vote against it. I want 
to vote for it. I think when people have to cast their votes on this, I 
think there will be more votes for it than against it, because I think 
most Senators understand the value and the moral and imperative aspect 
of seeing to it that children in this country have the kind of health 
care protection that they deserve.
  So let us vote on it. If you want to vote it down, vote it down. But 
let us not just talk about it endlessly hour after hour, day after day, 
because there are needs out here. This little fellow is counting on us 
to get something done here and not just come in here and blow a lot of 
hot air at each other.
  Cynthia Fyfe has just a little bit of coverage. But how does a child 
feel about the fact that his parents or parent is in a situation where 
they are going without health insurance coverage, let alone themselves? 
I mean, children love their parents. Think of the anxiety these people 
live with every single day.
  Do we want to live with that anxiety, those of us fortunate enough to 
have health insurance coverage? Are we prepared to give ours away or to 
do without it? Of course not, because we know how important it is. We 
would not want to put our family members in that kind of position of 
insecurity and danger. If you do not treat health needs ahead of time 
when you can or promptly when they arrive, it is dangerous. People die.
  I talked last week about Cheryl Eichler, a 29-year-old woman in 
Michigan, who was the manager of a 7-Eleven, with Crohn's disease; as 
lovely a person as I ever met. She came to testify before our committee 
one day on health care needs. She actually left the hospital to do it 
because she felt so desperately about the need for working people like 
herself to have health insurance coverage. She could not have it; did 
not have it; and could not afford to pay these medical bills. 
Oftentimes, she would delay going to the doctor when she was having 
terrible pains from this Crohn's disease.
  She died 6 months after she testified before our hearing, not quite 
30 years old. There is no doubt in my mind she would be alive today if 
she had gotten health care when she needed it. She should have gotten 
it.
  Other people in the country should have it. I am willing to pay my 
share so that other people can have it, because I do not want their 
kids going without the things they need. It is not good enough in 
America that some of us have it and some of us do not, not in this 
area.
  We are talking about something here that you need to have. We are 
talking about trying to keep people well and healthy.
  It is so basic and it is so fundamental. Why is it that we have such 
a hard time understanding the need to do it?
  I am open to the way to do it, quite frankly. If somebody can offer a 
better amendment than we have here, then I am willing to look at the 
amendment, as long as it covers the kids and the expectant mothers, as 
well.
  Why do we include expectant mothers here? Because we know that if a 
woman is carrying a child, if she goes to the doctor and gets good 
prenatal care, that child is going to much more likely go to full term, 
the full 9-month term of the pregnancy, and be a healthy baby, and then 
have a prospect for a good life down the road because they got off to a 
good start during the pregnancy and during the birth process.
  We know that we save many times over the money we spend on prenatal 
care for an expectant mother in terms of a good outcome from that 
birth, as opposed to denying that care and having the baby come early 
or having problems that could have been prevented and then spending 
tens of thousands of dollars, or even sometimes millions of dollars, to 
try to help these little tykes. Oftentimes, it is done through 
Medicaid, through the public assistance system.
  But it makes no sense. It does not make sense economically and it 
does not make sense morally. So we have to stop doing that.
  You know, that does not build a strong America. That hurts America. 
It hurts us in terms of our basic strength, because we are squandering 
people and squandering money and we are not holding ourselves out to a 
higher standard, which is what we ought to do in America. We sort of 
lift ourselves up to a higher standard of conduct with respect to what 
happens in our country that affects the lives of our people.
  Do you want people to love America? Do you want people in the 
underclass to care about this country? Well, I think we better make it 
clear that the country cares about them, as well; that this is a two-
way relationship. I think it is so fundamental.
  You could go into any church or synagogue or mosque in America or 
around the world and listen to what is being said by the religious 
leaders about what our relationship ought to be to one another. If 
there is not a foundation, a moral and an ethical and a religious 
foundation, in looking after each other's health needs, I do not know 
where there is one. It is so manifest.
  I have seen it, you know, in hospitals, as everybody here has. I lost 
both my mother and my father in the last 2 years. That has been a 
terribly painful experience, and I know what it is like for everybody 
else that goes through it.
  I watched, in the intensive care ward in St. Joseph's Hospital in 
Flint during both of those occasions, the dedicated services of the 
nurses, particularly, and the doctors and other caregivers to try to 
help people in these extreme situations. And I saw families, in 
addition to my own, going through these terrible moments, the travail 
and heartache and loss; sometimes recovery.
  Do we not want to be there helping? Do we not want to help each 
other? If we pass that accident scene by the side of the road, do we 
not want to help? I hope that we are the kind of country that, in our 
heart and soul, would say, ``Yes. Yes, we want to help.''
  We do not want to just go to Somalia and help; we do not want to just 
go to some other country around the world. We help every other country 
in the world, and a lot of that is necessary, and certainly it is 
driven by a humanitarian impulse. But is it more important to help the 
rest of the world than it is to help our own people? Are we going to 
find the money to help somebody in some distant land that we will never 
see, and say to little Anthony Fyfe here, ``I'm sorry; we can't get you 
up on the radar screen. You are not that important. We'd like to help, 
but we can't find the money. We can't, we can't, we can't, we can't.''
  Well, we can. We ought to start voting. The whole weekend went by 
with talk, even though there is an amendment right down at that desk 
right now. That reading clerk right now could call the roll on that 
amendment, and every one of the 100 Senators could say yes or no, and 
we could settle that issue. We could decide whether we want to cover 
the children or we do not want to cover the children. And then we could 
go on to other issues.
  I will finish in just a moment here. I feel very strongly about it.
  I think this is a very important moment for our country. There are 
times when we have a chance to sort of grow as a nation and grow up to 
a higher level of achievement and relationship of our Nation and 
ourselves to one another. This is one of those moments.
  It would be nice if it were simpler. The health care system is, by 
its very nature, complicated. It is 14 percent of the economy. It 
touches everybody in the country in one way or another. We know that 
going in.
  But there are some basic elements, some basic truths embedded in all 
of this, and one, sort of the bedrock is, are we going to see to it 
that people get the health care coverage and protection they need? Are 
we going to do that? Yes or no. Are we going to see that it gets done?
  Right now, this amendment says, all right, let us just take one group 
in this society. Let us take the most vulnerable group. Let us take the 
children, because they are not, in many cases, able to fend for 
themselves; certainly not 6-year-olds or 2-year-olds or 6-month-olds. 
They need somebody else helping.
  And if their families are in situations where they cannot get health 
care, cannot afford health care--now, if this little boy right now had 
asthma and his mother had money, she could not buy him a health 
insurance policy even if she had the money. Because the insurance 
companies do not want to insure a kid who needs the insurance. That is 
a preexisting condition. They would say no, we do not want Anthony, 
because he has an asthmatic problem.

  He is part of America. I want Anthony insured. I want every kid in 
America insured so they can get the care they need when they need it 
because it is right and because every child in this country is as 
important as every other child in this country. You should not have to 
be the child of somebody who is rich and famous and powerful, with a 
lot of money, in order to get health care protection in America. It 
ought to be there for every last kid in our country. Because each one 
is important. Each one is important.
  So let us vote. Let us vote--or at least let us set a time to vote. 
It is 10 minutes to 2 o'clock. What if we talk until 4? Or talk until 
6? Or talk until 8? Or talk until 10? Or talk until midnight? Or talk 
all night, if people want to talk all night. But then let us have a 
vote down here. Let us let that reading clerk right there call the 
roll. Call the 100 Senators' names, and let us find out where people 
are.
  If we do not have the votes then we do not have the votes. I think we 
may just have the votes. We will find out. But it is time we start 
voting and put an end to this filibuster and these delaying tactics.
  Once we have dealt with this amendment we will take an amendment from 
that side because we are going to rotate amendments. This amendment has 
come off the Democratic side. The next amendment, once we dispose of 
this one, will come off the Republican side. We will debate that 
amendment. And we will all vote on that and we will settle that issue 
and then we will rotate back over to an amendment on this side.
  But let us get at it. The country deserves an answer on this and not 
just a lot of additional hot air. We have an amendment at the desk. I 
have helped draft it. I think it is time that we vote on it.
  I reserve the remainder of my time.
  Several Senators addressed the Chair.
  The PRESIDENT pro tempore. The Senator from Oregon.
  Mr. PACKWOOD. I yield to the Senator from Missouri such time as he 
may need.
  The PRESIDENT pro tempore. The Senator from Missouri [Mr. Bond], is 
recognized for such time as he may require.
  Mr. BOND. Mr. President, my thanks to our distinguished ranking 
Republican on the Finance Committee. I wanted to congratulate my 
colleague and good friend from Michigan for his very compelling 
comments on why health care reform is needed. There are clearly some 
very, very good reasons for us to pass health care reform. That is why 
many of us on this side of the aisle have been working for better than 
4 years to develop effective, responsible, and private-sector solutions 
to the problems that we face in health care.
  It has been mentioned that we are engaged in endless debate. Let me 
point out to my colleagues and my constituents that we are seeing some 
very significant changes going on, literally as we speak. As we all 
know, there was a bill passed out by the Finance Committee and a bill 
passed out by the Labor Committee. Now our majority leader put forward, 
about 2 weeks ago, the Clinton-Mitchell I version. We started to work 
on that. And last week, then, another 1,400-plus page bill, Clinton-
Mitchell II, came out. And we had been working to understand what was 
in the first Clinton-Mitchell bill and we found out that there were 
some changes. Some of them were good. There were some outrageous things 
in the first one that were dropped out.
  I think my colleague from Michigan would be interested to know that 
one of the things, unfortunately, that was dropped out of the second 
Clinton-Mitchell version was something that he and I have been working 
on, on a bipartisan basis, for several years. We believe that one 
element, an important one but just one element in health care reform, 
is to establish a system by which we can go to electronic filing for 
health care insurance claims file processing and paying. This was 
developed on a bipartisan basis with the active participation of the 
Department of Health and Human Services, the people in the industry who 
provide health care information, groups from health care providers to 
the American Civil Liberties Union. We were working because it makes no 
sense to have a quill and scroll kind of recordkeeping in health care 
when it takes up one-seventh of the American economy. We waste $150 to 
$180 billion a year just on pushing paper, and it is a headache for 
each one of us who are consumers. It takes up too much time, it wastes 
money, and besides, we do not have good information on which to base 
long-term decisions about the utility of various health care 
procedures. It is called outcomes research. You need to have a good 
data base.
  We developed a proposal. We worked on it with the new administration, 
the Clinton administration's Health and Human Services. They signed off 
on it. We have groups from the ACLU to the AMA, the American Medical 
Association, American Hospital Association, and all the major data 
information groups which had come together on a good bill, and it was 
included in the Finance bill. It was included in the Labor bill. It was 
included in the first Clinton-Mitchell bill. But it got dropped out in 
the second Clinton-Mitchell bill. And that is part of the problem.
  I was on a talk show in Missouri this weekend and one of the callers 
said, ``Why are you saying you do not know what is in health care? You 
have been working on health care for over a year.''
  My answer on that is we have been working on health care a lot longer 
than that but we have had a different 1,400-plus-page amendment put in 
about every 3 or 4 days. And there was a third version that came out 
this Friday.
  As we are talking about it, we are reading it and trying to find out 
what goes into it. I think it is important for us to look at some of 
the problems in the current amendment by the majority leader that he 
would have us substitute for the Finance Committee bill. And with 
apologies to the people who were on late nights, we just picked 10 
reasons why, back at the home office in my State, the Mitchell bill 
should not be approved--the amendment by the majority leader.
  First, starting out with No. 10, ``Government-mandated purchasing 
groups are back.'' This was a feature of the original Clinton bill. 
They were called HIPC's, Health Insurance Purchasing Cooperatives. 
HIPC's became one of the first things that the public focused on, that 
is a Government-designated purchasing organization. Every State that 
had talked about having a mandated or a Government-run purchasing 
cooperative, a HIPC, moved away from it. The American people moved away 
from it as we discussed the original proposal by President Clinton. 
They looked like they were dead. However they have come back. They have 
come back in a new form.
  The Government will now designate its official HIPC in every region 
of the country. It will designate an existing purchasing cooperative as 
one of its HIPC's. And every employer in that area will have to 
designate one. It puts the Government-run purchasing group at the head 
of the line and it gives them the power to run the health care market 
as a bureaucracy. There is no option for the businesses, the employers 
in that area. They have to offer it.
   When they were first proposed the American people said, ``No, we 
don't want them. You would either have a choice between a State-run 
store or a private enterprise operation, and we have found in this 
country that the private operations are the ones that provide the best 
service at the best price.''
  Reason No. 9, the plaintiffs' attorneys, the trial lawyers, will love 
it. Because there are, shot through this bill, all kinds of incentives 
for people to sue their health plan. This creates a new private cause 
of action on which we could award damages if the plan does anything 
that would deprive anyone or tend to deprive anyone of health care or 
adversely affected access to health care services. This is a tremendous 
expansion of the civil rights measures. We worked very hard and passed 
a civil rights law a couple of years ago. This includes, in the new 
amendment which is offered by the majority leader, a whole range of new 
remedies and new causes of action for the attorneys who want to bring 
suits.
  We need real malpractice reform, not the encouragement of new suits. 
You can sue your health plan. The Attorney General can bring suits 
against health plans. And a recipient, a citizen, gets new grounds even 
to sue the State if they are not happy with the way the State operates.
  The Congressional Budget Office, in analyzing the first Mitchell 
plan, says that the plan would have great incentives for people to sue 
the health care providers. It says that it would offer significant 
encouragements to lawsuits that would be disruptive and that would have 
an adverse impact on costs, because the litigation costs would wind up 
being passed along to the others who are participating in the system.
  Reason No. 8, the States are given 177 new responsibilities and there 
are no grants for the States. If the States do not run the program the 
way the Federal Government wants it, they can take over the State 
programs. That is bad enough, but if this takeover occurs any time 
after January 1, 1997, then the Federal Government comes into that 
State and imposes a 15-percent surtax on all premiums. So that if a 
State does not like the way it is being told by the Federal Government 
to run it, the Federal Government has the ultimate club. The Federal 
Government takes over and the Secretary of Health and Human Services 
has the option to run it and impose a 15-percent surtax, driving up the 
cost of insurance to the people in the State.

  Again, the Congressional Budget Office says that the difficulties 
facing the States would be tremendously high.
  On page 11 of the Congressional Budget Office report, it states:

       The States have to certify standard health plans and health 
     insurance purchasing cooperatives, establish separate 
     guarantee funds for community rating and self-insured health 
     plans, monitor variations in the marketing fees of HIPC's and 
     other systems for purchasing insurance, and ensure carriers 
     meet minimum capital standards.

  These standards are largely federally determined, and the CBO said:

       It is doubtful that all States could develop the 
     capabilities to perform these functions effectively in the 
     near future.

  They go on to say in the system of subsidies, again quoting from page 
11:

       Integrating these three subsidies in a sensible and 
     administrable fashion would be extremely difficult especially 
     as some families could receive subsidies from more than one 
     program.

  And they point out several kinds of subsidies that would be very 
difficult to integrate.
  This, to me, seems like an open invitation to have the Federal 
Government take over the State responsibilities and move even more 
directly into the job of running and controlling health care in our 
Nation.
  Reason No. 7: Health care insurance premiums will skyrocket for young 
families. My colleagues, and those who have been following health care 
reform that has been implemented around this country, know that a real 
problem has arisen in New York because New York says everybody is going 
to pay the same insurance premium under their community-rating system, 
regardless of their age.
  The fact is that those of us who are older require more health care 
coverage than those who are younger. Typically in this country, as 
people get older, their incomes go up, so they are better able to 
afford that higher cost health insurance. But to go to strict community 
rating without age adjustment means that young families just getting 
started with small children and the burdens of starting a family will 
have to pay a subsidy in their health insurance program for their 
parents and for others in their parents' generation who, because of 
their age, simply have higher health care costs.
  We already have burdens on the working young today. They have to pay 
for the Social Security, they have to pay for Medicare for the seniors, 
and now there is going to be a windfall for the older wealthy who will 
be able to take advantage of the lower health care costs of the younger 
while the younger people are paying more in their premiums to take into 
account the fact that everybody has to be charged the same premium 
regardless of age.
  That simply does not make sense. That is the one reason that is 
driving the New York system to force younger people out of the plan. It 
is moving away from universal coverage.
  Reason No. 6: There are 50 new bureaucracies created in the Mitchell 
bill. I am not going to list all 50 here. But let me give you some of 
the most interesting.
  There is a Government health insurance purchasing cooperative; a 
National Health Benefits Board; a National Council on Graduate and 
Medical Education, and I believe the chairman of the Finance Committee, 
the distinguished senior Senator from New York, has pointed out that 
the Federal Government would use that body to determine what kind of 
degrees students at medical schools should receive, a very frightening 
prospect if you have followed the record of other Government agencies 
in predicting what various professions are going to need in the future.
  There is a National Council on Graduate Nurse Training; a National 
Advisory Board on Health Care Work Force Developments; there is the 
United States-Mexico Border Health Commission; there is a State 
Compliant Review Office; there is a Commission on Worker's Compensation 
Medical Services; and there is a National Health Care Cost and Coverage 
Commission.
  I do not believe we need more bureaucracies. We do not need 50 new 
bureaucracies. We need to fix what is wrong with health care, not 
create 50 new positions from which problems can arise in health care.
  Reason No. 5: Employer mandates will cost jobs. We have talked about 
that before. The Clinton plan went directly to employer mandates. 
Everybody knows that when you force a new cost on a business, there are 
several things that can happen: Either wages can go down or profits can 
go down, or, most likely, wages will either go down or people will be 
laid off.
  Under the Clinton-Mitchell plan, there is a trigger. If you do not 
reach 95 percent by the year 2000, then either Congress acts or an 
employer mandate and an individual mandate are triggered into effect in 
that State. It is not just a burden on the employer; it is a 
requirement that you, the individual, have to get insurance. The 
combination of these, No. 1 sets up such a mixed scheme. The 
Congressional Budget Office thinks there is no way to implement a 
State-by-State trigger. Let me tell you what would happen.
  If, for example, in my State, say Missouri was only at 94 percent--or 
it could happen in any other State; frankly, based on our experience, 
it might happen in most States--there would be a trigger and there 
would be a mandate that everybody in that State has to get insurance 
and employers would have the responsibility of providing 50 percent of 
their health care costs.
  The Congressional Budget Office has pointed out that this is going to 
have a significant impact on employment. On page 17 of the 
Congressional Budget Office report on the Mitchell bill, it says:

       The imposition of the mandate would raise the cost of 
     employing workers at firms that do not currently provide 
     insurance. Economic theory and empirical research both imply 
     most of this cost would be passed back over to workers in 
     time in the form of lower take-home wages.

  They go on to state that for people near the minimum wage, the likely 
outlook would be that they would lose their jobs or some of the 
employers could go out of business if, in fact, they were not able to 
pay those additional costs.
  If that mandate went into effect in my State but not in surrounding 
States, it is quite likely that the jobs would move out of our State 
into other States, further worsening an economic problem. This 
happened, as we all know, during the last decade in the Massachusetts 
miracle, where Massachusetts came up with a delayed employer mandate. 
As it got close to the time, the economy was collapsing, implementation 
of the employer mandate was postponed again and again because everybody 
realized in Massachusetts that if they had an employer mandate and 
other States did not, the jobs would pick up and move to the other 
States.
  Well, the people of Massachusetts imposed a remedy, a remedy I happen 
to believe was a sensible one. They elected a Republican Governor. But 
that, to me, is a recognition of the reality of employer mandates.
  Hard triggers are imposed regardless of the economic or social 
stability in the State. These hard triggers are likely to create 
uncertainty and chill economic growth, and they are simply a way to go 
after an employer mandate and an individual mandate without having to 
vote for it. You can say, ``Well, it is off in the future, so maybe I 
can get reelected before the people in my State feel the impact of the 
employer mandate and the burdens of the individual mandates, which 
would require major changes in the economy.''
  This hard trigger can produce irresistible demands for price 
controls, you can see workers being laid off--part- and full-time 
workers being laid off--delayed capital investment, hiring decisions 
and hiring of low-wage workers in a much less generous fashion.
  Reason No. 4: This creates a new trillion-dollar Federal entitlement 
program. The total subsidies under the Clinton-Mitchell plans 1 and 2--
and we have not had a chance to analyze fully the Clinton-Mitchell No. 
3 to see if there are any changes in it--but under the first two, the 
subsidies in the entitlement plan would cost over $1 trillion over 8 
years.
  This is a new entitlement of subsidies for low-income people to 
purchase health insurance. It is likely that they will be overly 
expensive, and as we have seen time and time again in other entitlement 
programs, they tend to cost far more than we expected they would cost. 
That is why we have an entitlement reform commission headed by the 
distinguished junior Senator from Nebraska and the senior Senator from 
my State, Senator Bob Kerrey and Senator Jack Danforth, who are warning 
us in this country that we are about to destroy our economic future, 
bankrupt the Federal Government, and put our children and grandchildren 
in a trick box that they can never get out of. That is by reason of the 
entitlements that grow like Topsy, and even worse. This is, I believe, 
a very frightening aspect of the Clinton-Mitchell bills 1, 2, and 3.
  No. 3, moving down to this line, this new bill--if I recall, 
President Clinton said, when he introduced his tax bill in 1993, that 
health care reform will save $300 billion over 5 years--results in $285 
billion additional spending on health care in the future.
  One of the reasons we got into the health care debate was to get 
costs under control. Now, we have all heard, and we talked about--and I 
agree with the statements here--the problems with people who do not 
have health insurance and the tragedies of people who have been denied 
health insurance when they or someone in their family have had a 
serious illness.
  That is something we have to remedy, but let us not forget the other 
side of the equation. We got into this health care reform debate 
because Medicare and Medicaid were eating the budget of the Federal 
Government, Medicaid was eating up State budgets, and health care costs 
were hitting businesses and the self-employed and retired people across 
this country.
  The costs of health care are going out of control. That is why 
President Clinton as a candidate endorsed managed competition, because 
where we have seen some success in getting health care costs under 
control is through the use of market-based competition. It can work and 
it will work. But we cannot afford another $285 billion of spending.
  Let me go back to what the Congressional Budget Office said about the 
spending. It says that there are going to be extremely high costs. They 
would have to be paid by taxes, a tax on high-cost health care plans. 
They are going to have a very complex system of generating the taxes 
and determining how much they cost. The expenses of the plan could be 
expected to grow with assessments, and such assessments would increase 
premiums, and in addition to costing more would discourage 
participation during the voluntary period.
  In the analysis by CBO, they say there ought to be a tax cap, with 
which I agree, on the tax deductibility to get costs under control 
rather than having new spending built into the plan.
  Reason No. 2--and this one is of concern to me because this one was 
in the original Clinton bill, as well as in this one--after the mandate 
clicks in, you do not have to pay your premiums. After the employer 
mandates, there are provisions in the bill that encourage freeloaders 
not to pay for coverage. Health plans cannot cancel health coverage for 
anyone who does not pay their insurance bill. That means once you go to 
a mandate, why bother to pay? Who pays? Well, the Mitchell bill imposes 
a collection shortfall add-on on honest workers and families to pay for 
freeloaders in the system. Now, freeloaders could get by with not 
paying their premiums and automatically passing on the payments to 
their honest neighbors.
  Guess what happens? Honest neighbors will not be able to pay either. 
And then we get somewhere I expect to get--Government running the whole 
system.
  That is one of the outcomes that I think is outrageous. It would not 
affect the low-income individuals for whom we are going to provide a 
100-percent subsidy for their premiums if they are at poverty level or 
below. It would affect the working middle class. And those who are 
dishonest or wanting to shirk their duties and stick the bill on their 
neighbors just would not pay, driving the cost up to where everybody 
would be forced out of the payment of premiums because they would go 
through the ceiling.
  Well, the first and best reason I think that the Mitchell bill will 
not fly is that it is longer than the Clinton bill. This latest volume 
is 1,443 pages long. I have talked about just a few of the problems in 
this bill. Every time we get a new version, we find new problems.
  This is a bill which contains so much we do not need that I believe 
we should start afresh and work with something that has either been 
passed by the committees so every provision has had a chance to be 
fully aired or we ought to adopt a shorter substitute. With all the 
bureaucracies, with all the taxes, with all the mandates on the States, 
there are too many things bad about this bill.
  I still believe, however, that we need health care reform in this 
country. I think the stage has been set. As I mentioned earlier, I have 
been working at Senator Dole's direction on the health care task force 
with Senator Chafee and many of my colleagues for over 4 years. Week 
after week, we looked at what was wrong with health care and developed 
reasons and ways of improving the health care system. During that time, 
we fought battles with the Bush administration to try to get them to 
move forward with health care. Frankly, they did not do it, and I 
commend the President and Mrs. Clinton for making health care reform a 
priority because I think there are things that need to be done.
  We need to make sure that people do not lose their health care if 
they get sick. We need to make sure that those who cannot afford it now 
can get resources to get health care. We need to cut down on expensive 
malpractice costs. But most of all, we need to get the system under the 
control that the marketplace will accomplish for us. We have lost 
track, when we are considering a 1,400-page bill, of doing the things 
that need to be done and not doing others.
  I have been told by person after person in my home State of Missouri, 
as I have been back and talked and listened to them for the last 
several months: We do not want a Government bureaucracy running health 
care. Sure, we would like to see changes in health care, but do not 
hurt it. We do not want a system that does more harm. We do not want to 
see ill-considered, extensive, bureaucratic, overreaching Federal 
legislation.
  The first principle of medicine is do no harm. In politics, the first 
principle ought to be if it is not broke, do not fix it. Well, I think 
that these 1,400-plus pages fix far more than is broken.
  I believe the American people want us to have a bipartisan plan. I 
think they want to have something in which every American can have 
confidence. They want to have something with which they can go forward 
and say this has been fully considered and we have a good, sound basis 
for health care reform.
  We have heard from the White House that, well, maybe it would be 
enough just to get a bill through here with 51 votes. Then they can 
take it to conference and no telling what will happen. As has already 
been pointed out on this floor, if we are going to make major changes 
in a program that affects every one of us and consumes one-seventh of 
our national economy, our gross domestic product, we better do it with 
broad bipartisan agreement so that the people of America can know that 
they are getting something that has been fully considered, fully aired, 
and has the best interests of the people of America at heart.
  First, we need to get everyone into the system. We know that there 
are about 39 million people uninsured in this country today. If we are 
going to make sure that everyone gets into the system, we need to know 
who these people are. Who are the uninsured? Most of the uninsured are 
working adults--57 percent. There are 25 percent of them who are 
uninsured children, and the unemployed are 18 percent. Most of the 
uninsured are in families headed by a worker--84 percent. Perhaps most 
revealing is that most of the uninsured are farm families headed by a 
worker employed continuously throughout the year--never unemployed. 
That is 60 percent.
  In fact, the largest segment of uninsured live in families headed by 
a full-time worker. Where do the working uninsured work? Well, most of 
them work in the retail trade, the services industry, or other areas. 
You have 7 percent in government, 18 percent in services, 23 percent 
are self-employed, 26 percent in retail, 32 percent in construction, 
and 46 percent in agriculture.
  We need to eliminate barriers. First, we have to make sure that 
people are treated fairly under the tax laws. Most of the people in 
agriculture are farm families.
  I listened to farm families throughout Missouri say, ``Why don't we 
get to deduct 25 percent of our health insurance premiums? That is not 
fair.'' And I agree. Somebody working with a very wealthy corporation 
can have unlimited benefits, tax free to the employee and tax 
deductible by the employer. But the farmer and his or her family only 
get to deduct 25 percent. That is why the figures are so high in 
agriculture. That is a disincentive. That is a glitch in our tax system 
that we have to deal with.
  People in the retail trade, if they work for a retailer--and the 
average profit margin for the retail employee in the country today is 
$1,700--if the employer does not provide health insurance, then the 
employee working full time in a retail establishment has to pay 100 
percent--no tax deduction.
  So the Tax Code itself causes, as some have estimated, as many as 9 
million people to be uninsured.
  Then next we would go to Federal subsidies to purchase insurance. 
Generally the subsidies that have been agreed on by a Republican and 
Democratic basis alike are from 100 percent of subsidy and 100 percent 
of poverty phasing out at 150 percent to 200 percent to 240 percent. 
This is a major undertaking by the Federal Government. This is 
something we have to pay for. But this is to make sure that no one is 
denied health access and health services because they cannot afford the 
insurance.
  Once they get it, however--and one of the things that scares many 
people is that they will lose their health care insurance once they 
have it.
  I have heard of too many problems, too many tragedies of families who 
thought they had good insurance policies, and, if they had a major, 
catastrophic illness to a parent or even to a child, they have found 
their health insurance canceled or their premiums jacked up through the 
roof. We cannot accept that. I think everybody in this body, on each 
side of the aisle, would agree that the time has come to stop that 
practice.
  Health insurance reform ought to ensure that health insurance spreads 
the risk, not allow a sharp, practicing company to come in and cherry 
pick off very low premiums to healthy people, then throw them out, and 
somebody that they covered gets sick. This, to me, does not make sense.
  The next major goal of health care reform is to contain costs. I 
believe that the marketplace will work. We have seen where groups of 
employers or groups in a community get together to purchase health care 
insurance. They have the information. They go to health care providers 
and get information on the quality and cost of care. They can make a 
tremendous difference in the cost of insurance.
  I talked with people who are working in a small purchasing 
cooperative through a third party administrator in Springfield, MO. 
Some of them have been in the program for 7 years, and they find their 
health care costs are still what they were 7 years ago. They have not 
come back up to that height because they are exercising the discipline 
of the marketplace. It is the discipline of the marketplace that gives 
us the best standard of living in the world, whether it be for food, 
clothing, or anything else you want. It has made a success out of the 
rest of our economy. The reason that marketplace competition has not 
worked in the United States is because there have been impediments, 
first dollar coverage which takes away any incentive to purchase health 
care services wisely and at the best cost.
  I believe we need more managed competition, not more Government 
bureaucracy. I believe that the Mitchell bill is Government run amuck, 
with all the bureaucracies, with millions and millions of dollars in 
new spending only marginally relevant to the urgent health care needs 
of our Nation.
  Here are just a few:
  There is $50 million per year for school-based health education. I 
believe health education is important. But I believe that local 
communities and local school boards should decide upon the curriculum 
and fund the program, not the Federal Government,
  There is $82 million a year for school-based services. The idea is to 
get the children into health care services so they are covered by a 
health plan.
  We do not need to be paying more money for school-based services from 
the Federal Government. The Federal Government is going broke rapidly. 
Let us not start piling more expensive programs on it.
  There is $200 million per year for the Department of Labor to retrain 
and deploy displaced health care workers.
  We thought that when the Clinton bill was initially proposed, that 
there would not be any displacement or dislocation. In addition, there 
are about 154 different training programs in any event. So why do we 
need more training programs.
  There is $92 million a year for OSHA, the Occupational Safety and 
Health Administration. A new program entitled ``Occupational Injury and 
Illness Prevention.'' I thought that was the job of the agency already. 
What are we funding it for? Why do they need another $92 million?
  Let us take these new spending programs out, consider them 
separately, and if they are really needed, if we need to tell OSHA what 
it is supposed to prevent, occupational illness and injury prevention, 
let us cut out some of the money we are now providing OSHA, and tell 
them you ought to be preventing occupational illness and injury. That 
seems to be what the agency was all about. I would like to see them go 
back and do that job.
  Another problem is that it makes the women, infants and children 
spending program mandatory. It becomes an entitlement program. I 
support the women, infants and children, the WIC program, and have 
backed efforts in the Agriculture Appropriations Subcommittee to move 
the program towards full funding. Why do we set it up as a new 
entitlement that is called an entitlement which would join the others 
in growing without control, without legislative oversight?
  I believe we need reform that puts Americans, not politics, first. I 
am committed to working to get a bill on this Senate floor that will do 
the job and that will do it right. We cannot walk away from families 
who desperately need relief from insurance company cherry picking. They 
need affordable coverage, and they should not have to wait as we fuss 
about the Government bureaucracy bill. We need to have both sides 
working together.
  I think there is a lot we can agree on. I think we could get a solid 
majority in this body, and I would hope the other body would follow 
us--to say that these are the things that are wrong. Let us do what 
really is necessary, and what is pressing now. But let us throw the 
baggage overboard. There are too many burdens. There are too many 
costs. There are too many taxes. There are too many mandates. This 
Clinton-Mitchell bill in any of its transmogrifications from 1 to 2 to 
3 is a far bigger bite than we can or should bite off because I do not 
intend to vote for a bill that would harm the health care system, that 
would further burden our Government, and that would put the people of 
American at the dependence of the Federal Government to get health 
care.
  This is an effort to put big Government first. We do not need that. I 
think there are key features that a majority agree are essential to 
achieve real health care reform. I will work for a bill that includes 
those and leaves the rest out.
  First, fair tax treatment for the self-employed and uninsured.
  Second, insurance market reforms to ensure you do not lose your 
health care coverage or your insurance, or have your premiums escalated 
if you get sick or lose your job.
  Third, provide subsidies for low-income individuals not covered by 
health care now.
  Fourth, real malpractice reform.
  I commend the majority leader because between transmogrification one 
and two, he knocked out a provision that would have preempted all State 
malpractice reform laws. The State of Missouri and the State of 
California have gone a long way. First, they were going to repeal all 
of the State laws. We do not need that. We need real malpractice 
reform.
  Fifth, we need to move toward electronic filing of health care 
claims, information with privacy protection, security protections to 
the individuals, so their health information is not disclosed. We need 
electronic filing to lower costs, to provide better information on the 
effectiveness of health care procedures. I hope we can go back to the 
provision that, along with Senator Riegle in this body and with a 
bipartisan cosponsorship in the House, we have already worked on.
  Finally, I believe that we need to rely on the market competition to 
keep health care costs under control.
  Madam President, I believe these are the outlines of a bill we can 
pursue, and we can achieve great things. I will continue to work with 
my colleagues on both sides of the aisle. We do not need 1,400 pages of 
bureaucracy. We do need real health care reform. I stand ready to work 
with my colleagues to achieve it.
  I reserve the remainder of my time.
  Mr. HATCH addressed the Chair.
  The PRESIDING OFFICER. The Senator from Utah [Mr. Hatch], is 
recognized.
  Mr. HATCH. I ask unanimous consent to speak as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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